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

Primary practice address
105 W Main St Rexburg ID 83440-2634
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
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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