Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CHIA835 | ID |
NPI | 1649237603 |
---|---|
Provider Name | Dr. Kirk Elliot Parge |
First Address | Priest River, ID 83856-0897 |
Second Address | Priest River, ID 83856-9207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 08/07/2007 |