NPIMap

Organization Active NPI

Evergreen Wellness Group LLC

  • Chiropractor
  • Meridian, ID
National Provider Identifier
1477820215
Registry record updated Nov 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIA-1153 Issued in ID
Legal business name
EVERGREEN WELLNESS GROUP LLC
Practice address
1640 W Cherry LN
Suite 130
Meridian, ID 83642-8187
Phone
(208) 895-8595
Fax
(208) 895-8594
NPI assigned
Nov 22, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2011

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

Authorized official

Name
Dr. Matthew D Hales, D.C.NPI 1295742690
Title
Owner
Phone
(208) 895-8595

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X CHIA-1153 ID Primary

Addresses

Primary practice location

1640 W Cherry LN
Suite 130
Meridian, ID 83642-8187

Mailing address

1640 W Cherry LN
Suite 130
Meridian, ID 83642-8187
Phone (208) 895-8595

Other identifiers 1

IdentifierTypeStateIssuer
1700106663MedicaidID

Other names 1

  • Evergreen Chiropractic Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1321920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321920000000",
    "number": "1477820215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 W CHERRY LN",
            "address_2": "SUITE 130",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836428187",
            "telephone_number": "208-895-8595",
            "fax_number": "208-895-8594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 W CHERRY LN",
            "address_2": "SUITE 130",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836428187",
            "telephone_number": "208-895-8595",
            "fax_number": "208-895-8594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN WELLNESS GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-22",
        "last_updated": "2011-11-22",
        "status": "A",
        "authorized_official_last_name": "HALES",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-895-8595",
        "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-1153",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700106663",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Nov 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.