NPIMap

Organization Active NPI

Optimal Health Ventures LLC Dba Boise Integrated Chiropractic

  • Chiropractor
  • Boise, ID
National Provider Identifier
1700364437
Registry record updated Feb 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIA-1368 Issued in ID
Legal business name
OPTIMAL HEALTH VENTURES LLC DBA BOISE INTEGRATED CHIROPRACTIC
Practice address
3224 N Maple Grove Rd
Boise, ID 83704-4214
Phone
(208) 629-5374
NPI assigned
Aug 3, 2018
Organization subpart
Yes
Parent organization
BOISE INTEGRATED CHIROPRACTICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 7, 2020

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

Authorized official

Name
Dr. Noah B. Edvalson, DC
Title
Owner - Physician
Phone
(208) 629-5374

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X CHIA-1368 ID Primary

Addresses

Primary practice location

3224 N Maple Grove Rd
Boise, ID 83704-4214

Mailing address

3271 N Milwaukee St
Boise, ID 83704-4425
Phone (208) 629-5374

Other names 1

  • Boise Integrated Chiropractic Doing business as

National Provider Directory

National Provider Directory
Part of
Optimal Health Ventures LLC

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1533254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581033600000",
    "number": "1700364437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3271 N MILWAUKEE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837044425",
            "telephone_number": "208-629-5374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3224 N MAPLE GROVE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837044214",
            "telephone_number": "208-629-5374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL HEALTH VENTURES LLC DBA BOISE INTEGRATED CHIROPRACTIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOISE INTEGRATED CHIROPRACTIC",
        "enumeration_date": "2018-08-03",
        "last_updated": "2020-02-07",
        "certification_date": "2020-02-07",
        "status": "A",
        "authorized_official_last_name": "EDVALSON",
        "authorized_official_first_name": "NOAH",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "OWNER - PHYSICIAN",
        "authorized_official_telephone_number": "208-629-5374",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "CHIA-1368",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boise Integrated Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2020; 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.