Nicolas Asla
Individual provider Active NPI Chiropractor · Boise, ID
NPI 1780150292 · NPPES record last updated Oct 23, 2018
Key facts
- NPI
- 1780150292
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- CHIA1890 (ID)
- Practice address
- 403 S 11TH St Ste 110
Boise, ID 83702-6968 - Phone
- (208) 343-6900
- Fax
- (208) 343-0642
- NPI assigned
- Oct 23, 2018
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Western States College of Chiropractic, 2018
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Idaho Chiropractic Group, PLLC
Practice addresses (Care Compare)
403 S 11TH St
Suite 110
Boise, ID 83702-6968
Phone (208) 343-6900
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190328001322 | ID | Practitioner - Chiropractic | 0345580353 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CHIA1890 | ID | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Idaho Chiropractic Group, PLLC | Chiropractor | Current |
Accepting new patients |
Locations
403 S 11th St
Ste 110
Boise, ID 83702
Phone (208) 343-6900
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | CHIA1890 | ID | Yes |
Addresses
Primary practice location
403 S 11TH St Ste 110
Boise, ID 83702-6968
Mailing address
403 S 11TH St Ste 110
Boise, ID 83702-6968
Phone (208) 343-6900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CHIA1890 | Other | ID | IDAHO STATE LICENSE |
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 Oct 23, 2018. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.