Organization
TOTAL LIFE CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELBYANN BERNICE ALDRIDGE (OFFICE MANAGER)
(208) 878-6413
Entity
Organization
Contact information
Practice address
2311 PARK AVE, UNIT 2 SUITE 6&8, BURLEY, ID 83318-2104
(208) 878-6413
(208) 878-6417
Mailing address
2311 PARK AVE, UNIT 2 SUITE 6&8, BURLEY, ID 83318-2104
(208) 878-6413
(208) 878-6417
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467816199
—
ID
Enumeration date
04/08/2016
Last updated
03/16/2023
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