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Organization

EVERGREEN WELLNESS GROUP LLC

Active
Other names
Evergreen Chiropractic
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MATTHEW D HALES D.C. (OWNER)
(208) 895-8595
Entity
Organization

Contact information

Practice address
1640 W CHERRY LN, SUITE 130, MERIDIAN, ID 83642-8187
(208) 895-8595
(208) 895-8594
Mailing address
1640 W CHERRY LN, SUITE 130, MERIDIAN, ID 83642-8187
(208) 895-8595
(208) 895-8594

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-1153
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1700106663
ID
Enumeration date
11/22/2011
Last updated
11/22/2011
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