NPIMap

Organization Active NPI

Full Life Chiropractic, PA

  • Chiropractor
  • Meridian, ID
National Provider Identifier
1740472844
Registry record updated Dec 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
C9495 Issued in ID
Legal business name
FULL LIFE CHIROPRACTIC, PA
Practice address
2300 W Everest LN
Suite #175
Meridian, ID 83646-5925
Phone
(208) 895-0858
Fax
(208) 895-0561
NPI assigned
Aug 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2010

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

Authorized official

Name
Dr. Jonathan Eric Main, DCNPI 1790810380
Title
Owner / President
Phone
(208) 895-0858

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X C9495 ID Primary

Addresses

Primary practice location

2300 W Everest LN
Suite #175
Meridian, ID 83646-5925

Mailing address

2300 W Everest LN
Suite #175
Meridian, ID 83646-5925
Phone (208) 895-0858

Other identifiers 1

IdentifierTypeStateIssuer
C9722OtherIDBCBS

Other names 1

  • Main Health Solutions Doing business as

National Provider Directory

National Provider Directory

Locations

2300 W Everest Ln
Ste 175
Meridian, ID 83646
Phone (208) 895-0858

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": "1186963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292803200000",
    "number": "1740472844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 W EVEREST LN",
            "address_2": "SUITE #175",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836465925",
            "telephone_number": "208-895-0858",
            "fax_number": "208-895-0561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 W EVEREST LN",
            "address_2": "SUITE #175",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836465925",
            "telephone_number": "208-895-0858",
            "fax_number": "208-895-0561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL LIFE CHIROPRACTIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-13",
        "last_updated": "2010-12-20",
        "status": "A",
        "authorized_official_last_name": "MAIN",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "ERIC",
        "authorized_official_title_or_position": "OWNER / PRESIDENT",
        "authorized_official_telephone_number": "208-895-0858",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "C9495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "C9722",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Health Solutions",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Dec 20, 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.