The Other Road Incorporated

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

THE OTHER ROAD INCORPORATED

Practice address

1640 W Cherry LN # 130
Meridian, ID 83642-8187

Phone

(208) 895-8595

Fax

(208) 895-8594

NPI assigned

Jun 2, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Matthew David Hales, D.C.

Title

Vice-President

Phone

(208) 895-8595

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Evergreen Chiropractic Doing business as

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

{
    "created_epoch": "1275436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275436800000",
    "number": "1700106663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 W CHERRY LN # 130",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836428187",
            "telephone_number": "208-895-8595",
            "fax_number": "208-895-8594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 W CHERRY LN # 130",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836428187",
            "telephone_number": "208-895-8595",
            "fax_number": "208-895-8594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE OTHER ROAD INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-02",
        "last_updated": "2010-06-02",
        "status": "A",
        "authorized_official_last_name": "HALES",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "208-895-8595",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUC CROSS GROUP#",
            "identifier": "8M574",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Chiropractor in Meridian, ID
• Providers in Meridian, ID by specialty
• Chiropractor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.