Idaho Chiropractic Group, PLLC
Organization Active NPI Chiropractor · Boise, ID
NPI 1639280712 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1639280712
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- CHIA-559 (ID)
- Legal business name
- IDAHO CHIROPRACTIC GROUP, PLLC
- Practice address
- 403 S 11TH St
Suite #110
Boise, ID 83702-6968 - Phone
- (208) 343-6900
- Fax
- (208) 343-0642
- NPI assigned
- Aug 31, 2006
- Organization subpart
- No
Authorized official
- Name
- Julie Careaga
- Title
- Billing Manager
- Phone
- (208) 343-6900
Practitioners 4
-
Timothy Klena, D.C.
-
Corey Matthews, D.C.
-
Kendrick L. Tweedt, D.C., C.C.S.P.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 13D2226590 | Idaho Chiropractic Group | Certificate of waiver | Jun 1, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070501000245 | ID | Part B Supplier - Clinic/Group Practice | 6305942764 |
Receives reassigned benefits from 3 practitioners Practice locations: Boise, ID |
National Provider Directory
Locations
403 S 11th St
Ste 110
Boise, ID 83702
Phone (208) 343-6900
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | CHIA-802 | ID | |
| Chiropractor |
111N00000X | CHIA-559 | ID | Yes |
Addresses
Primary practice location
403 S 11TH St
Suite #110
Boise, ID 83702-6968
Mailing address
PO Box 7442
Boise, ID 83707-1442
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C1526 | Other | ID | BLUE CROSS |
| 000010027629 | Other | ID | BLUE SHIELD |
Other providers in Boise, ID
- Idaho Center for Autism, LLC
- Idaho Center for Autism, LLC
- Idaho Center for Autism, LLC
- Idaho Center for Reproductive Medicine PC
- Idaho Chiropractic Company LLC
- Idaho Cleft and Craniofacial Pediatric Plastic Surgery, P.a.
- Idaho Clinic
- Idaho Concierge Medicine LLC
- Idaho CRH Surgeons PC
- Idaho CVS Pharmacy LLC
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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.