Individual provider Active NPI

Raymond Drew Flack

  • Chiropractor
  • Meridian, ID
National Provider Identifier
1235641374
Registry record updated May 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIA-1802 Issued in ID
Practice address
3405 E Overland Rd Ste 110
Meridian, ID 83642-5111
Phone
(208) 888-4646
NPI assigned
Oct 30, 2017
Last updated
May 14, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CHIA-1802 ID Primary

Addresses

Primary practice location

3405 E Overland Rd Ste 110
Meridian, ID 83642-5111

Mailing address

9508 W Fairview Ave
Boise, ID 83704-8103
Phone (208) 323-1313

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191231002275 ID Practitioner - Chiropractic 9537593439 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2017
Medicare assignment
May accept Medicare assignment
Group practices
Price Chiropractic Center CharteredGroup PAC ID 2466719513, 3 clinicians

Practice addresses (Care Compare)

9508 W Fairview Ave
Boise, ID 83704-8103
Phone (208) 323-1313

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CHIA-1802IDMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Price Chiropractic Center Chartered CurrentSince Oct 15, 2019 Accepting new patients

Locations

9508 W Fairview Ave
Boise, ID 83704
Phone (208) 323-1313

Interoperability endpoints

  • Direct secure messaging: pricechiropracticcenter.drewflack@144289.advancedmd-direct.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1509321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747180800000",
    "number": "1235641374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9508 W FAIRVIEW AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048103",
            "telephone_number": "208-323-1313",
            "fax_number": "208-323-1368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3405 E OVERLAND RD STE 110",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425111",
            "telephone_number": "208-888-4646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLACK",
        "first_name": "RAYMOND",
        "middle_name": "DREW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-30",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "CHIA-1802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.