Bly, Gretchen Michelle
Bly, Gretchen Michelle is an individual health care provider with primary practice located at 105 W Main St , Rexburg ID 83440-2634. She recently has only one registered license in Chiropractic Providers / Chiropractor, which is considered as her primary health care specialty. Bly, Gretchen Michelle can be contacted via phone (208) 356-6772.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Chiropractic Providers / Chiropractor | 111N00000X | CHIA-1037 | Idaho |
Profile Details
| NPI number | 1073630984 |
|---|---|
| LBN Legal business name | Bly, Gretchen Michelle |
| Credentials | Doctor of Chiropractic (DC) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 24th, 2007 |
| Last updated | Aug 8th, 2009 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1073630984 | NPPES |
| Idaho | Other | 16711661 | MEDICARE GROUP PTAN |
| Idaho | MEDICAID | 806710900 | MEDICARE GROUP PTAN |
| Idaho | Other | 16753471 | MEDICARE GROUP PTAN |
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