Back Pain Solutions Clinic Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

BACK PAIN SOLUTIONS CLINIC INC

Practice address

827 W Prairie Ave
Hayden, ID 83835-8459

Phone

(208) 660-9378

Fax

(208) 758-8527

NPI assigned

Aug 12, 2021

Last updated

Aug 18, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Christopher Bowman

Title

Vice President

Phone

(280) 967-5608

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1628726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629244800000",
    "number": "1891460754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "827 W PRAIRIE AVE",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838358459",
            "telephone_number": "208-660-9378",
            "fax_number": "208-758-8527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "827 W PRAIRIE AVE",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838358459",
            "telephone_number": "208-660-9378",
            "fax_number": "208-758-8527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACK PAIN SOLUTIONS CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-12",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A",
        "authorized_official_last_name": "BOWMAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "280-967-5608"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2021; 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.