Chubbuck Chiropractic PA
Organization Active NPI Chiropractor · Chubbuck, ID
NPI 1508993189 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1508993189
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- Legal business name
- CHUBBUCK CHIROPRACTIC PA
- Practice address
- 445 W Chubbuck Rd
Ste a
Chubbuck, ID 83202-2308 - Phone
- (208) 637-8800
- NPI assigned
- Feb 28, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Jeremy W. Hale, DC
- Title
- President
- Phone
- (208) 637-8800
Practitioners 1
-
Jeremy W Hale, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040709001247 | ID | Part B Supplier - Clinic/Group Practice | 6103804794 |
Receives reassigned benefits from 1 practitioner Practice locations: Chubbuck, ID |
National Provider Directory
Locations
445 W Chubbuck Rd
Ste A
Chubbuck, ID 83202
Phone (208) 637-8800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | Yes |
Addresses
Primary practice location
445 W Chubbuck Rd
Ste a
Chubbuck, ID 83202-2308
Mailing address
445 W Chubbuck Rd
Ste a
Chubbuck, ID 83202-2308
Phone (208) 637-8800
Other providers in Chubbuck, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.