Provider Demographics
NPI:1306129002
Name:ALLIANCE SOFT TISSUE CENTER
Entity type:Organization
Organization Name:ALLIANCE SOFT TISSUE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:RACE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-949-5592
Mailing Address - Street 1:4700 N CLOVERDALE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1081
Mailing Address - Country:US
Mailing Address - Phone:208-322-7900
Mailing Address - Fax:208-322-6405
Practice Address - Street 1:4700 N CLOVERDALE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-1081
Practice Address - Country:US
Practice Address - Phone:208-322-7900
Practice Address - Fax:208-322-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1233111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty