EASTERN IDAHO SPINE CENTER NPI 1154593705

NPI Information

EASTERN IDAHO SPINE CENTER is a rehabilitation practitioner in Idaho Falls, ID. The provider is a health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity. EASTERN IDAHO SPINE CENTER NPI is 1154593705. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2860 CHANNING WAY
STE 112
IDAHO FALLS, ID
ZIP 83404-531
Phone: (208) 535-4343
Fax: (208) 535-4344

The provider's authorized official is Shane Christian Mangrum .
The authorized official title is Owner and has the following contact phone number (208) 535-4343.

The enumeration date for this NPI number is 3/24/2008 and was last updated on 6/6/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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