Eagle Sport & Family Chiropractic PLLC
Chiropractor, Sports Physician in Eagle, ID. Organization (NPI-2).
NPI number1861574410
StatusActive
Last updated in NPPESApr 3, 2013
Details
- NPI
- 1861574410
- Entity type
- Organization (NPI-2)
- Legal business name
- Eagle Sport & Family Chiropractic PLLC
- Organization subpart
- No
- Enumeration date
- Oct 20, 2006
- Last updated
- Apr 3, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 111NS0005X | Chiropractor, Sports Physician | CHIA-1073 | ID | Yes |
Practice location
547 S Fitness PlSuite 110
Eagle, ID 83616-6552
Phone 208-939-3986 · Fax 208-319-2700
Mailing address
547 S Fitness PlSuite 110
Eagle, ID 83616-6552
Phone 208-939-3986 · Fax 208-319-2700
Authorized official
Kraig K Knotts
Owner
2089393986
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