Organization
UPPER CERVICAL CLINICS OF IDAHO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRAYSON BLOM D.C. (PRESIDENT)
(208) 559-0541
Entity
Organization
Contact information
Practice address
3023 E COPPER POINT DR STE 104, MERIDIAN, ID 83642-1740
(208) 559-0541
Mailing address
3211 CAMROSE LN, BOISE, ID 83706-2710
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
CHIA-1297
ID
Other
Enumeration date
04/30/2008
Last updated
04/30/2008
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