13D2150793 CLIA NUMBER - LEGACY HEALTH PARTNERS

Laboratory Demographics

CLIA Number: 13D2150793

Facility Name: LEGACY HEALTH PARTNERS

Facility Address:
333 S WOODRUFF AVE
IDAHO FALLS, ID
ZIP 83401
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Facility Phone Number: 208 522-2591

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1184801946

Taxonomy: 111N00000X - Chiropractor
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

CLIA Record

Field Name	Field Value
CLIA Number	13D2150793
LAB Type	Physician Office
Facility Name	LEGACY HEALTH PARTNERS
Street	333 S WOODRUFF AVE
City	IDAHO FALLS
State	ID
ZIP	83401
Phone	208 522-2591
CertificateType	4
CertificateEffectiveDate	7/3/2022
CertificateExpirationDate	7/2/2024
FacilityType	Waiver

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