Individual provider Active NPI

Dax Sirucek, DC, DACNB

  • Neurology Chiropractor
  • Meridian, ID
National Provider Identifier
1669654935
Registry record updated Jun 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology ChiropractorTaxonomy code 111NN0400X
License
CHIA-1276 Issued in ID
Practice address
3080 E Gentry Way
110
Meridian, ID 83642-3544
Phone
(208) 345-7262
Fax
(208) 343-1953
NPI assigned
Nov 28, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Chiropractor 111NN0400X CHIA-1276 ID Primary

Addresses

Primary practice location

3080 E Gentry Way
110
Meridian, ID 83642-3544

Mailing address

3080 E Gentry Way
110
Meridian, ID 83642-3544
Phone (208) 345-7262

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090415000147 ID Practitioner - Chiropractic 9537216288 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College - West, 2007
Medicare assignment
May accept Medicare assignment
Group practices
Sirucek Chiropractic Neurology Clinic IncGroup PAC ID 3072660729, 2 clinicians

Practice addresses (Care Compare)

3080 E Gentry Way
Suite 110
Meridian, ID 83642-3060
Phone (208) 345-7262

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CHIA-1276IDMDNeurology Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Sirucek Chiropractic Neurology Clinic, Inc. Neurology CurrentSince Nov 30, 2017 Accepting new patients

Locations

3152 S Bown Way
Boise, ID 83706
Phone (208) 345-7262

3080 E Gentry Way
Ste 110
Meridian, ID 83642
Phone (208) 345-7262

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1196208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308614400000",
    "number": "1669654935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3080 E GENTRY WAY",
            "address_2": "110",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836423544",
            "telephone_number": "208-345-7262",
            "fax_number": "208-343-1953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3080 E GENTRY WAY",
            "address_2": "110",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836423544",
            "telephone_number": "208-345-7262",
            "fax_number": "208-343-1953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIRUCEK",
        "first_name": "DAX",
        "name_prefix": "Dr.",
        "credential": "DC, DACNB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-28",
        "last_updated": "2011-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NN0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Neurology",
            "state": "ID",
            "license": "CHIA-1276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jun 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.