Organization
WIGHT CHIROPRACTIC, PA
Active
Other names
Legacy Health Partners
Organization subpart
No
Provider details
NPI number
Authorized official
GARY CHRISTOPHER WIGHT DC (PRESIDENT)
(208) 522-2591
Entity
Organization
Contact information
Practice address
333 S. WOODRUFF AVE, IDAHO FALLS, ID 83401
(208) 522-2591
(208) 522-2591
Mailing address
333 S. WOODRUFF AVE, IDAHO FALLS, ID 83401
(208) 522-2591
(208) 522-2591
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA 1163
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1369151
MEDICARE GROUP #
ID
01
—
C9672
BLUE CROSS GROUP #
ID
Enumeration date
01/23/2008
Last updated
04/16/2019
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