Idaho Spine Clinic LLC

NPI #1679805535 in Malad City, Idaho

Provider Information

NPI Number: 1679805535
Entity Type: Organization
Organization Name: Idaho Spine Clinic LLC
Primary Specialty: Chiropractor
Enumeration Date: Feb 3, 2010
Last Updated: Feb 3, 2010

Practice Location

Address: 148 E 50 S
City: Malad City
State: Idaho
ZIP Code: 83252-1368
Phone: (208) 766-8111

Authorized Official

Name: DR. RONALD EUGENE PERRY, DC
Title: DOCTOR OF CHIROPRACTIC
Phone: (208) 766-8111

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Chiropractor	111N00000X	Primary

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