Organization
PRESTON CHIROPRACTIC CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEONARD E. WARD D.C. (OWNER)
(208) 852-0083
Entity
Organization
Contact information
Practice address
122 N STATE ST, PRESTON, ID 83263-1143
(208) 852-0083
(208) 852-0051
Mailing address
122 N STATE ST, PRESTON, ID 83263-1143
(208) 852-0083
(208) 852-0051
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010008535
BLUE SHIELD
ID
01
—
C4876
BLUE CROSS
ID
Enumeration date
08/30/2010
Last updated
12/01/2011
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