Organization
BRAD EGBERT CHIROPRACTIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRAD EGBERT D.C. (OWNER/MANAGER)
(208) 356-8818
Entity
Organization
Contact information
Practice address
1134 BOND AVE, REXBURG, ID 83440-3582
(208) 356-8818
(208) 356-0458
Mailing address
1134 BOND AVE, REXBURG, ID 83440-3582
(208) 356-8818
(208) 356-0458
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA543
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1134279565
PERSONAL NPI NUMBER
ID
Enumeration date
09/10/2008
Last updated
09/10/2008
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