Active NPI
Grayson Blom, D.C.
- Chiropractor
- Boise, ID
National Provider Identifier
1316112428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CHIA-1297
- Practice address
- 5975 W. Overland Rd.
Boise, ID 83709 - Phone
- (208) 559-0541
- NPI assigned
- Apr 29, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CHIA-1297 | ID | Primary |
Addresses
Primary practice location
5975 W. Overland Rd.
Boise, ID 83709
Mailing address
4869 W Malad St
Ste D
Boise, ID 83705-8844
Phone (208) 559-0541
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CHIA-1297 | ID | MD | Chiropractor |
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 and National Provider Directory roles.
-
- Clinic/Center
- Meridian, ID
- NPI 1316113368
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478649600000",
"number": "1316112428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4869 W MALAD ST",
"address_2": "STE D",
"city": "BOISE",
"state": "ID",
"postal_code": "837058844",
"telephone_number": "208-559-0541"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5975 W. OVERLAND RD.",
"city": "BOISE",
"state": "ID",
"postal_code": "83709",
"telephone_number": "208-559-0541"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLOM",
"first_name": "GRAYSON",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-29",
"last_updated": "2016-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "ID",
"license": "CHIA-1297",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.