| |
810 E Sherman Ave, Coeur D Alene, ID 83814-4149 | |
(208) 665-2293 | |
(208) 664-8973 |
Full Name | |
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Type | Facility |
Speciality | Clinic/center - Multi-specialty |
Location | 810 E Sherman Ave, Coeur D Alene, Idaho |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1063922805 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
171100000X | Acupuncturist | ACU-283 (Idaho) | Secondary |
175F00000X | Naturopath | (* (Not Available)) | Secondary |
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
Provider Name | Melissa Marie Trost |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1619597895 PECOS PAC ID: 7113348400 Enrollment ID: I20200521001694 |
Provider Name | Thor Stephen Bostrom |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1609479419 PECOS PAC ID: 2163807843 Enrollment ID: I20220915003354 |
Mailing Address | Practice Location Address |
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Po Box 3482, Post Falls, ID 83877-3482 Ph: (208) 209-6170 | 810 E Sherman Ave, Coeur D Alene, ID 83814-4149 Ph: (208) 665-2293 |