Organization
GROTHMAN, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY W GROTHMAN D.C. (OWNER)
(208) 777-7463
Entity
Organization
Contact information
Practice address
2525 E SELTICE WAY, STE C, POST FALLS, ID 83854-5089
(208) 777-7463
(208) 777-9769
Mailing address
2525 E SELTICE WAY, STE C, POST FALLS, ID 83854-5089
(208) 777-7463
(208) 777-9769
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA 808
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0124306
WASHINGTON LABOR AND INDUSTRIES
ID
01
—
C4330
BLUE CROSS OF IDAHO
ID
Enumeration date
04/16/2013
Last updated
04/16/2013
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