Eastern Idaho Spine Center
NPI #1154593705 in Idaho Falls, Idaho
Provider Information
- NPI Number
- 1154593705
- Entity Type
- Organization
- Organization Name
- Eastern Idaho Spine Center
- Primary Specialty
- Rehabilitation Practitioner
- Enumeration Date
- Mar 24, 2008
- Last Updated
- Jun 6, 2008
Practice Location
- Address
- 2860 CHANNING WAY
- Address 2
- STE 112
- City
- Idaho Falls
- State
- Idaho
- ZIP Code
- 83404-7531
- Phone
- (208) 535-4343
Authorized Official
- Name
- DR. SHANE CHRISTIAN MANGRUM, M.D.
- Title
- OWNER
- Phone
- (208) 535-4343
Specialties & Taxonomy Codes
| Specialty |
|---|
| Rehabilitation Practitioner |
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