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Organization

NORTHERN LAKES CHIROPRACTIC CLINIC, P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. RYAN LEISY DC (CEO)
(208) 265-1900
Entity
Organization

Contact information

Practice address
30544 HIGHWAY 200 STE 330, PONDERAY, ID 83852-5005
(208) 265-1900
(208) 227-8313
Mailing address
30544 HIGHWAY 200 STE 330, PONDERAY, ID 83852-5005
(208) 265-1900
(208) 227-8313

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-1250
ID

Other

Enumeration date
02/27/2008
Last updated
03/29/2018
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