Provider Demographics
NPI:1063826535
Name:PRICE CHIROPRACTIC CENTER CHARTERED
Entity Type:Organization
Organization Name:PRICE CHIROPRACTIC CENTER CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-323-1313
Mailing Address - Street 1:9508 W FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8103
Mailing Address - Country:US
Mailing Address - Phone:208-323-1313
Mailing Address - Fax:208-323-1386
Practice Address - Street 1:9508 W FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8103
Practice Address - Country:US
Practice Address - Phone:208-323-1313
Practice Address - Fax:208-323-1386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-452111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDCHIA-452OtherCHIROPRACTIC LICENSE
IDT44480Medicare UPIN