Hayden Lake Chiropractic PA

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CHIA-699 Issued in ID

Legal business name

HAYDEN LAKE CHIROPRACTIC PA

Practice address

8235 N Cornerstone Dr
Hayden, ID 83835-8683

Phone

(208) 762-0222

Fax

(208) 762-5362

NPI assigned

Jan 24, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Kevin Robert Marsh, D.C.NPI 1922144773

Title

President

Phone

(208) 762-0222

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Practitioners 1

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

• Kevin Robert Marsh, D.C.

  • Chiropractor
  • Hayden, ID
  • NPI 1922144773
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1390521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390521600000",
    "number": "1417370511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8235 N CORNERSTONE DR",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838358683",
            "telephone_number": "208-762-0222",
            "fax_number": "208-762-5362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8235 N CORNERSTONE DR",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838358683",
            "telephone_number": "208-762-0222",
            "fax_number": "208-762-5362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAYDEN LAKE CHIROPRACTIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-24",
        "last_updated": "2014-01-24",
        "status": "A",
        "authorized_official_last_name": "MARSH",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-762-0222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "CHIA-699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2014; 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.