13D2313728 CLIA NUMBER - MIND AND BODY RESTORED

Laboratory Demographics

  • CLIA Code: 13D2313728
  • Facility Name: MIND AND BODY RESTORED
  • Facility Address: 913 W CANFIELD AVE
    COEUR D'ALENE, ID
    ZIP 83815
  • Facility Phone: (208) 957-7808
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: JANA M. QUALLS
  • NPI Number: 1295420651
  • Taxonomy: 208VP0000X - Pain Medicine

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CLIA Record

Field Name Field Value
CLIA Number 13D2313728
LAB Type Practitioner Other
Facility Name MIND AND BODY RESTORED
Street 913 W CANFIELD AVE
City COEUR D'ALENE
State ID
ZIP 83815
Phone 2089577808
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/6/2024
Certificate Expiration Date 11/5/2026
Facility Type Practitioner Other
Lab Director JANA M. QUALLS

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This page was last updated on: 5/18/2026