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UPPER CERVICAL CLINICS OF IDAHO

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Company Details

Name: UPPER CERVICAL CLINICS OF IDAHO
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 04 Mar 2008 (17 years ago)
Entity Number: 367416
Place of Formation: IDAHO
File Number: 0000367416
ZIP code: 83713
County: Ada County
Mailing Address: 3211 CAMROSE LN BOISE, ID 83713

National Provider Identifier

NPI Number:
1316113368

Authorized Person:

Name:
GRAYSON BLOM
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
261Q00000X - Clinic/Center
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Initial Filing 0000367416 2008-03-04

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Date of last update: 25 Sep 2024

Sources: Idaho Secretary of State