Organization
EASTERN IDAHO CHIROPRACTIC CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY DEAN NELSON D.C.N.M.D (CHIROPRACTIC NATUROPATHIC MEDICAL)
(208) 522-0200
Entity
Organization
Contact information
Practice address
2585 CHANNING WAY, IDAHO FALLS, ID 83404-7516
(208) 522-0200
(208) 523-6051
Mailing address
2585 CHANNING WAY, IDAHO FALLS, ID 83404-7516
(208) 522-0200
(208) 523-6051
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010020547
BLUE SHIELD INSURANCE
ID
01
—
C9453
BLUE CROSS INSURANCE
ID
Enumeration date
11/30/2006
Last updated
12/18/2015
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