Organization
ELLISON FAMILY CHIROPRACTIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY CRAIG ELLISON D.C. (OWNER)
(208) 884-8848
Entity
Organization
Contact information
Practice address
3225 W BAVARIA ST, SUITE 101, EAGLE, ID 83616-5413
(208) 884-8848
(208) 884-8802
Mailing address
3225 W BAVARIA ST, SUITE 101, EAGLE, ID 83616-5413
(208) 884-8848
(208) 884-8802
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-845
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807028500
—
ID
Enumeration date
02/18/2010
Last updated
04/04/2012
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