Individual
DR. MARIA M MARICICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
131 4TH ST. E, SUITE 310, KETCHUM, ID 83340
(208) 726-6010
(208) 726-6010
Mailing address
PO BOX 6459, KETCHUM, ID 83340
(208) 726-6010
(208) 726-6010
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
C622
ID
111NI0900X
Internist Chiropractor
Primary
CHIA622
ID
111NN1001X
Nutrition Chiropractor
CHIA622
ID
111NP0017X
Pediatric Chiropractor
CHIA622
ID
111NS0005X
Sports Physician Chiropractor
CHIA622
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000-1002-0870
BLUE SHEILD
ID
01
—
C622-8
BLUE CROSS
ID
Enumeration date
02/07/2007
Last updated
03/25/2014
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