Provider Demographics
NPI:1043399363
Name:DAHL, N ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:N
Middle Name:ERIC
Last Name:DAHL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10451 W GARVERDALE CT
Mailing Address - Street 2:STE. 204
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5408
Mailing Address - Country:US
Mailing Address - Phone:208-377-2225
Mailing Address - Fax:208-377-2299
Practice Address - Street 1:10451 W GARVERDALE CT
Practice Address - Street 2:STE. 204
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5408
Practice Address - Country:US
Practice Address - Phone:208-377-2225
Practice Address - Fax:208-377-2299
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA 1013111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDU94013Medicare UPIN
ID1675173Medicare ID - Type Unspecified