Jacalyn Renae Amrine, D.C.
Individual provider Active NPI Chiropractor · Eagle, ID
NPI 1003185265 · NPPES record last updated Jan 20, 2025
Key facts
- NPI
- 1003185265
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- CHIA-1930 (ID)
- Practice address
- 435 E Shore Dr Ste 130
Eagle, ID 83616-5754 - Phone
- (208) 917-1929
- Fax
- (208) 485-9629
- NPI assigned
- Dec 17, 2011
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Life Chiropractic College - West, 2011
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
435 E Shore Dr
Suite 130
Eagle, ID 83616-5754
Phone (208) 917-1929
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200131000844 | ID | Practitioner - Chiropractic | 6901058833 | Practice locations: Eagle, ID |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CHIA-1930 | ID | MD | Chiropractor |
| 32089 | CA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Malcolm D. Hill, M.D., Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 32089 | CA | |
| Chiropractor | 111N00000X | CHIA-1930 | ID | Yes |
Addresses
Primary practice location
435 E Shore Dr Ste 130
Eagle, ID 83616-5754
Mailing address
435 E Shore Dr Ste 130
Eagle, ID 83616-5754
Phone (208) 917-1929
Other names
- Jacalyn Renae Marossy
Other providers in Eagle, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 20, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.