Organization
ACTIVE LIVING CHIROPRACTIC & WELLNESS LLC
Active
Other names
Active Living Chiropractic and Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRYSTA MILLER (BILLING SPECIALIST)
(208) 939-0775
Entity
Organization
Contact information
Practice address
13999 W WAINWRIGHT DR STE 201, BOISE, ID 83713-1969
(208) 939-0775
(208) 575-6114
Mailing address
13999 W WAINWRIGHT DR STE 201, BOISE, ID 83713-1969
(208) 939-0775
(208) 575-6114
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
IDTPID012211
—
ID
Enumeration date
11/05/2018
Last updated
02/19/2019
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