Organization
PRIMARY CARE CHIROPRACTIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONDA L. MATTLEY D.C. (OWNER)
(208) 461-4227
Entity
Organization
Contact information
Practice address
1004 13TH AVE S, NAMPA, ID 83651-4621
(208) 461-4227
(208) 461-3411
Mailing address
1004 13TH AVE S, NAMPA, ID 83651-4621
(208) 461-4227
(208) 461-3411
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-1005
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010141491
BLUE SHIELD OF IDAHO
ID
01
—
C2979
BLUE CROSS OF IDAHO
ID
Enumeration date
01/07/2008
Last updated
06/19/2008
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