Provider Demographics
NPI:1396089728
Name:EASTLAND CHIROPRACTIC, P.A
Entity type:Organization
Organization Name:EASTLAND CHIROPRACTIC, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SENECAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CIRS
Authorized Official - Phone:208-734-7077
Mailing Address - Street 1:1126 EASTLAND DR N STE 300
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-8951
Mailing Address - Country:US
Mailing Address - Phone:208-734-7077
Mailing Address - Fax:208-734-7101
Practice Address - Street 1:1126 EASTLAND DR N STE 300
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-8951
Practice Address - Country:US
Practice Address - Phone:208-734-7077
Practice Address - Fax:208-734-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty