Provider Demographics
NPI:1427212661
Name:SLEEPING SPINE HEALTH & WELLNESS, PLLC
Entity type:Organization
Organization Name:SLEEPING SPINE HEALTH & WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-237-2723
Mailing Address - Street 1:1246 YELLOWSTONE AVE STE C4
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4373
Mailing Address - Country:US
Mailing Address - Phone:208-237-2723
Mailing Address - Fax:208-237-2723
Practice Address - Street 1:1246 YELLOWSTONE AVE STE C4
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4373
Practice Address - Country:US
Practice Address - Phone:208-237-2723
Practice Address - Fax:208-237-2723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA1150111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807411000Medicaid
IDC9677OtherBLUE CROSS OF IDAHO
ID10159964OtherREGENCE BLUE SHIELD OF IDAHO