Provider Demographics
NPI:1316275969
Name:IDAHO SCOLIOSIS SPECIALISTS PLLC
Entity type:Organization
Organization Name:IDAHO SCOLIOSIS SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-888-0055
Mailing Address - Street 1:10751 W OVERLAND RD
Mailing Address - Street 2:SUITE A 62
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1375
Mailing Address - Country:US
Mailing Address - Phone:208-888-0055
Mailing Address - Fax:208-888-5062
Practice Address - Street 1:10751 W OVERLAND RD
Practice Address - Street 2:SUITE A 62
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1375
Practice Address - Country:US
Practice Address - Phone:208-888-0055
Practice Address - Fax:208-888-5062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty