Active NPI
Dax Sirucek, DC, DACNB
- Neurology Chiropractor
- Meridian, ID
National Provider Identifier
1669654935
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Chiropractor
- License
- CHIA-1276
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Life Chiropractic College - West, 2007
- Medicare assignment
- May accept Medicare assignment
- Group practices
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
| License | State | Type | Specialty |
|---|---|---|---|
| CHIA-1276 | ID | MD | Neurology Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sirucek Chiropractic Neurology Clinic, Inc. | Neurology | Current | 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.
-
- Neurology Chiropractor
- Meridian, ID
- NPI 1093975302
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.