Organization
ADVANCED CHIROPRACTIC OF BLACKFOOT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEE SCOTT STEVENS (OWNER OPERATOR)
(208) 785-0270
Entity
Organization
Contact information
Practice address
1395 NW MAIN ST, BLACKFOOT, ID 83221-3936
(208) 785-0270
(208) 785-0683
Mailing address
725 JENSEN GROVE DR, SUITE #4, BLACKFOOT, ID 83221-1636
(208) 785-0270
(208) 785-0683
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
CHIA-1502
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZIR91475
TRADING PARTNER
ID
Enumeration date
11/23/2016
Last updated
11/04/2019
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