Individual
DR. GROVER LYNN MALLARD
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
3320 10TH ST, LEWISTON, ID 83501
(208) 746-5226
(208) 746-5268
Mailing address
3320 10TH ST, LEWISTON, ID 83501
(208) 746-5226
(208) 746-5268
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA832
ID
Other
Enumeration date
08/19/2005
Last updated
07/08/2007
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