Individual
SHALOAM OFISA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C., M.S.
Contact information
Practice address
1800 FLANDRO DR, SUITE 130, POCATELLO, ID 83202
(208) 221-2973
Mailing address
1800 FLANDRO DR, SUITE 130, POCATELLO, ID 83202-4912
(208) 242-3723
(208) 904-1052
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-1603
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952713166
—
ID
Enumeration date
05/22/2014
Last updated
07/10/2018
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