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Organization

LAKELAND CHIROPRACTIC PA

Active
Other names
Lakeland Chiropractic Clinic
Organization subpart
No

Provider details

NPI number
Authorized official
JANI SUE HALL (OFFICE MANAGER)
(208) 687-7029
Entity
Organization

Contact information

Practice address
14822 N HIGHWAY 41, RATHDRUM, ID 83858-8461
(208) 687-7029
Mailing address
14822 N HIGHWAY 41, RATHDRUM, ID 83858-8461
(208) 687-7029

Taxonomy

Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
CHIA-924
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1881705366
MEDICAID, BLUE SHIELD OF IDAHO
Enumeration date
05/30/2017
Last updated
07/21/2022
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