Northern Lakes Chiropractic Clinic, P.c.

NPI #1710156443 in Ponderay, Idaho

Provider Information

NPI Number: 1710156443
Entity Type: Organization
Organization Name: Northern Lakes Chiropractic Clinic, P.c.
Primary Specialty: Chiropractor
Enumeration Date: Feb 27, 2008
Last Updated: Mar 29, 2018

Practice Location

Address: 30544 HIGHWAY 200 STE 330
City: Ponderay
State: Idaho
ZIP Code: 83852-5005
Phone: (208) 265-1900

Authorized Official

Name: DR. RYAN LEISY, DC
Title: CEO
Phone: (208) 265-1900

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Chiropractor	111N00000X	Primary

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