| Upper Cervical Clinics Of Idaho | |
|
3023 E Copper Point Dr Ste 104 Meridian ID 83642-1740 | |
| (208) 559-0541 | |
| Not Available |
| Full Name | Upper Cervical Clinics Of Idaho |
|---|---|
| Speciality | Clinic/Center |
| Location | 3023 E Copper Point Dr Ste 104, Meridian, Idaho |
| Authorized Official Name and Position | Grayson Blom (PRESIDENT) |
| Authorized Official Contact | 2085590541 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Upper Cervical Clinics Of Idaho 3211 Camrose Ln Boise ID 83706-2710 Ph: () - | Upper Cervical Clinics Of Idaho 3023 E Copper Point Dr Ste 104 Meridian ID 83642-1740 Ph: (208) 559-0541 |
| NPI Number | 1316113368 |
|---|---|
| Provider Enumeration Date | 04/30/2008 |
| Last Update Date | 04/30/2008 |
| Medicare PECOS PAC ID | 1052441029 |
|---|---|
| Medicare Enrollment ID | O20100617000861 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316113368 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | CHIA-1297 (Idaho) | Primary |
| Provider Name | Grayson Blom |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1316112428 PECOS PAC ID: 2961532932 Enrollment ID: I20100617000865 |
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