Organization
STAKER CHIROPRACTIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERALD D STAKER D.C. (PRESIDENT)
(208) 522-5546
Entity
Organization
Contact information
Practice address
976 JOHN ADAMS PKWY, IDAHO FALLS, ID 83401-4049
(208) 522-5546
(208) 522-4777
Mailing address
976 JOHN ADAMS PKWY, IDAHO FALLS, ID 83401-4049
(208) 522-5546
(208) 522-4777
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA706
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002776700
—
ID
Enumeration date
02/23/2010
Last updated
02/23/2010
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