Provider Demographics
NPI:1700066875
Name:CHIROPRACTIC HEALTH STRATEGIES, PA
Entity type:Organization
Organization Name:CHIROPRACTIC HEALTH STRATEGIES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRANDSTAFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-772-6015
Mailing Address - Street 1:7905 N MEADOWLARK WAY
Mailing Address - Street 2:B
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-5041
Mailing Address - Country:US
Mailing Address - Phone:208-772-6015
Mailing Address - Fax:208-227-6016
Practice Address - Street 1:7905 N MEADOWLARK WAY
Practice Address - Street 2:B
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-5041
Practice Address - Country:US
Practice Address - Phone:208-772-6015
Practice Address - Fax:208-227-6016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID668111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDU38041Medicare UPIN