Organization
ENERGETIC CHIROPRACTIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL MYRTH MORIARTY D.C. (OWNER/PRESIDENT)
(208) 376-3113
Entity
Organization
Contact information
Practice address
1003 N. ORCHARD STREET, BOISE, ID 83706-2231
(208) 376-3113
(208) 376-4114
Mailing address
1003 N ORCHARD ST, BOISE, ID 83706-2231
(208) 376-3113
(208) 376-4114
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
C392
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010009131
REGENCE BLUE SHIELD OF ID
ID
01
—
1831197086
PROVIDER INDIVIDUAL NPI
ID
01
—
3928
BLUE CROSS OF IDAHO
ID
Enumeration date
10/02/2006
Last updated
01/04/2012
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