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Individual

KOLTON WILLIAM DONOVAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DC

Contact information

Practice address
2090 S EAGLE RD, MERIDIAN, ID 83642-6707
(208) 921-1112
Mailing address
2090 S EAGLE RD, MERIDIAN, ID 83642-6707
(208) 921-1112

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-2318
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
CHIA-2318
LICENSE
ID
Enumeration date
01/10/2023
Last updated
01/10/2023
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