Organization
THE OTHER ROAD INCORPORATED
Active
Other names
Evergreen Chiropractic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW DAVID HALES D.C. (VICE-PRESIDENT)
(208) 895-8595
Entity
Organization
Contact information
Practice address
1640 W CHERRY LN # 130, MERIDIAN, ID 83642-8187
(208) 895-8595
(208) 895-8594
Mailing address
1640 W CHERRY LN # 130, MERIDIAN, ID 83642-8187
(208) 895-8595
(208) 895-8594
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8M574
BLUC CROSS GROUP#
ID
Enumeration date
06/02/2010
Last updated
06/02/2010
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