Individual
BRUCE KITCHEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
13403 N GOVERNMENT WAY, HAYDEN LAKE, ID 83835-9460
(208) 215-9372
Mailing address
23203 E KILLARNEY LAKE RD, CATALDO, ID 83810-9324
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MASG-1028
ID
Other
Enumeration date
01/16/2014
Last updated
01/16/2014
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