Organization
LAKELAND CHIROPRACTIC PA
Active
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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