OrganizationActive
Eastern Idaho Spine Center
NPI 1154593705 · Rehabilitation Practitioner · Idaho Falls, ID
Provider details
- NPI number
- 1154593705
- Entity type
- Organization
- Primary specialty
- Rehabilitation PractitionerRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Organization subpart
- No
- Authorized official
- Shane Mangrum, Owner(208) 535-4343
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Profile Score
Detailed profile(87/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2860 Channing Way
Ste 112
Idaho Falls, ID 83404-7531
Phone: (208) 535-4343
Fax: (208) 535-4344
Street-level locationGet directions
Mailing address
2860 Channing Way
Idaho Falls, ID 83404-7531
Registry dates
- Enumerated
- 2008-03-24
- Last updated
- 2008-06-06
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.