Legacy Chiropractic PLLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

LEGACY CHIROPRACTIC PLLC

Practice address

20 N Fisher Park Way Ste 100
Eagle, ID 83616-4709

Phone

(206) 313-3733

NPI assigned

May 19, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Brent Symes, D.C.NPI 1508940859

Title

Owner

Phone

(206) 313-3733

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brent Symes, DC

  • Chiropractor
  • Eagle, ID
  • NPI 1508940859
  Medicare reassignment NPD Authorized official
• Christopher Deja

  • Massage Therapist
  • Eagle, ID
  • NPI 1568391050
  NPD (past)

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

{
    "created_epoch": "1621382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629072000000",
    "number": "1336713858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 996",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836160002",
            "telephone_number": "206-313-3733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 N FISHER PARK WAY STE 100",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836164709",
            "telephone_number": "206-313-3733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY CHIROPRACTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-19",
        "last_updated": "2021-08-16",
        "certification_date": "2021-08-16",
        "status": "A",
        "authorized_official_last_name": "SYMES",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-313-3733",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donald E Larson, D.M.D.
• Sean Michael Lawson
• Brandon Taylor Leal, DPT
• Chelsea Lynn Leatherman, LPC
• Kristen Leenhouts, PA-C
• Karly J Leib, RN
• Alisha Lauren Lema, NP
• William Thomas Levanduski, OT
• Level Up Family Dental
• Danika Kristan Lewis, LMT

• Chiropractor in Eagle, ID
• Providers in Eagle, ID by specialty
• Chiropractor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2021; 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.

Verify at the official NPI Registry.