Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Eastern Idaho Spine Center

Organization Rehabilitation Practitioner · NPI 1154593705

Eastern Idaho Spine Center is a Rehabilitation Practitioner in Idaho Falls, Idaho. Registered with an NPI since 2008.

In the registry since
2008

Practice location Address checks out

2860 Channing Way Ste 112
Idaho Falls, ID 83404-7531
Phone: (208) 535-4343
Fax: (208) 535-4344
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Rehabilitation Practitioner (primary) Taxonomy 225400000X

Record details

NPI number1154593705
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Shane Mangrum — Owner · (208) 535-4343
NPI enumeratedMarch 24, 2008
Last updated in NPPESJune 6, 2008
Mailing address2860 Channing Way, Ste 112, Idaho Falls, ID 83404-7531

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