Evergreen Wellness Group LLC

NPI #1477820215 in Meridian, Idaho

Provider Information

NPI Number: 1477820215
Entity Type: Organization
Organization Name: Evergreen Wellness Group LLC
Primary Specialty: Chiropractor
Enumeration Date: Nov 22, 2011
Last Updated: Nov 22, 2011

Practice Location

Address: 1640 W CHERRY LN
Address 2: SUITE 130
City: Meridian
State: Idaho
ZIP Code: 83642-8187
Phone: (208) 895-8595

Authorized Official

Name: DR. MATTHEW D HALES, D.C.
Title: OWNER
Phone: (208) 895-8595

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Chiropractor	111N00000X	Primary

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