Active Chiropractic, PC
Organization Active NPI Chiropractor · Boise, ID
NPI 1679724330 · NPPES record last updated Feb 18, 2010
Key facts
- NPI
- 1679724330
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- CHIA-1209 (ID)
- Legal business name
- ACTIVE CHIROPRACTIC, PC
- Practice address
- 1521 E Boise Ave
Boise, ID 83706-5064 - Phone
- (208) 345-3320
- NPI assigned
- Sep 30, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. Jason Watson, DC
- Title
- President
- Phone
- (208) 345-3320
Practitioners 3
-
Jason Watson, D.C.
-
Mark Anthony Betsill, D.C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081105000313 | ID | Part B Supplier - Clinic/Group Practice | 8729147780 |
Receives reassigned benefits from 1 practitioner Practice locations: Boise, ID |
National Provider Directory
Locations
1521 E Boise Ave
Boise, ID 83706
Phone (208) 344-5433
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | CHIA-1209 | ID | Yes |
Addresses
Primary practice location
1521 E Boise Ave
Boise, ID 83706-5064
Mailing address
1521 E Boise Ave
Boise, ID 83706-5064
Phone (208) 345-3320
Other names
- Active Chiropractic
Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2010. 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.