Organization
BOISE SPINE & ORTHOPEDIC BRACING, LLC
Active
Organization
BOISE SPINE & ORTHOPEDIC BRACING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN KYLE BURTENSHAW DC (PHYSICIAN/OWNER)
(208) 870-5209
Entity
Organization
Contact information
Practice address
757 E WYTHE CREEK CT, 102B, KUNA, ID 83634-5006
(208) 639-9329
(208) 881-0103
Mailing address
757 E WYTHE CREEK CT, 102B, KUNA, ID 83634-5006
(208) 639-9329
(208) 881-0103
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7627500001
NSC
ID
Enumeration date
12/07/2016
Last updated
07/21/2022
Update your record
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