13D1025447 CLIA NUMBER - BACK COUNTRY CHIROPRACTIC & WELLNESS

Laboratory Demographics

CLIA Number: 13D1025447

Facility Name: BACK COUNTRY CHIROPRACTIC & WELLNESS

Facility Address:
201 PARK STREET
MC CALL, ID
ZIP 83638
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Facility Phone Number: 208 634-8129

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1861555286

Taxonomy: 111NI0900X - Chiropractor
The chiropractic internist may serve as a primary care physician or may see patients referred from other providers for evaluation and co-management. Evaluation is focused on the early detection of functional, nutritional, and pathological disorders. A chiropractic internist utilizes the diagnostic instruments necessary for proper examination. In cases where laboratory examination is necessary, a chiropractic internist utilizes a recognized reference laboratory facility. A chiropractic internist may manage his or her own cases or may refer to another specialist when prudent to do so. The chiropractic internist utilizes documented natural therapies, therapeutic lifestyle changes, patient education and other resources to promote patient health and avoidance of disease.

CLIA Record

Field Name	Field Value
CLIA Number	13D1025447
LAB Type	Practitioner Other
Facility Name	BACK COUNTRY CHIROPRACTIC & WELLNESS
Street	201 PARK STREET
City	MC CALL
State	ID
ZIP	83638
Phone	208 634-8129
CertificateType	4
CertificateEffectiveDate	5/7/2024
CertificateExpirationDate	5/6/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024