Organization
GRAND TETON CHIROPRACTIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES CRIDDLE GARDNER D.C. (OWNER/MANAGER)
(208) 529-1919
Entity
Organization
Contact information
Practice address
1387 CAMBRIDGE DR, SUITE 100, IDAHO FALLS, ID 83401-4257
(208) 529-1919
(208) 552-9447
Mailing address
4317 AMBER LN, AMMON, ID 83406-4640
(208) 529-1919
(208) 552-9447
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA 904
ID
Other
Enumeration date
10/04/2006
Last updated
08/22/2020
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