Organization
GOTT CHIROPRACTIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE MICHAEL GOTT D.C. (CEO)
(208) 794-4774
Entity
Organization
Contact information
Practice address
3183 N. COLE RD., BOISE, ID 83704
(208) 794-4774
Mailing address
13871 W. DOMINION CT., BOISE, ID 83713-0718
(208) 794-4774
(208) 466-9240
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
CHIA 490
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001758900
—
ID
01
—
732653
OPTUM HEALTH
ID
01
—
C9771
BLUE CROSS OF IDAHO
ID
Enumeration date
10/15/2009
Last updated
10/15/2009
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