Broadway Chiropractic Center Professional Association

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

C373 Issued in ID

Legal business name

BROADWAY CHIROPRACTIC CENTER PROFESSIONAL ASSOCIATION

Practice address

1149 W Boise Ave
Boise, ID 83706-3503

Phone

(208) 345-3630

Fax

(208) 345-3640

NPI assigned

Feb 7, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Donald D Rae, D.C.NPI 1629173760

Title

Owner/ President

Phone

(208) 345-3630

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Rae Chiropractic Center Other name

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.

• Donald D Rae, D.C.

  • Chiropractor
  • Boise, ID
  • NPI 1629173760
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296086400000",
    "number": "1487794541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1149 W BOISE AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063503",
            "telephone_number": "208-345-3630",
            "fax_number": "208-345-3640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1149 W BOISE AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063503",
            "telephone_number": "208-345-3630",
            "fax_number": "208-345-3640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY CHIROPRACTIC CENTER PROFESSIONAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2011-01-27",
        "status": "A",
        "authorized_official_last_name": "RAE",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER/ PRESIDENT",
        "authorized_official_telephone_number": "208-345-3630",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "C373",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "C9511",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010145978",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rae Chiropractic Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Brittany Blockman MD PC
• Troy Britton, CRNA
• Megan Broadbent
• Broader Wellness, LLC
• Christopher Broadnax
• Hanna Brock
• Natalie Brock, FNP
• Seiji Brock, LCPC
• Debra Jean Brockert, LMSW
• Daniel J Broderick, DO

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2011; 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.