Organization
LILJENQUIST CHIROPRACTIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CODY S. LILJENQUIST D.C. (OWNER/CHIROPRACTOR)
(208) 678-2631
Entity
Organization
Contact information
Practice address
1700 OVERLAND AVENUE, BURLEY, ID 83318
(208) 678-2631
(208) 678-3334
Mailing address
1700 OVERLAND AVENUE, BURLEY, ID 83318
(208) 678-2631
(208) 678-3334
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH1A577
ID
171100000X
Acupuncturist
ACC-78
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002663000
—
ID
Enumeration date
03/07/2011
Last updated
03/07/2011
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