Individual
GRAYSON BLOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
5975 W. OVERLAND RD., BOISE, ID 83709
(208) 559-0541
Mailing address
4869 W MALAD ST, STE D, BOISE, ID 83705-8844
(208) 559-0541
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-1297
ID
Other
Enumeration date
04/29/2008
Last updated
11/09/2016
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