Provider Demographics
NPI:1073529202
Name:PEINE, CHRISTOPHER C (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:C
Last Name:PEINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:507 S FITNESS PL
Mailing Address - Street 2:STE 110
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6552
Mailing Address - Country:US
Mailing Address - Phone:208-947-0925
Mailing Address - Fax:208-947-0926
Practice Address - Street 1:507 S FITNESS PL
Practice Address - Street 2:STE 110
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6552
Practice Address - Country:US
Practice Address - Phone:208-947-0926
Practice Address - Fax:831-636-6108
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDO-0366204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDI13546Medicare UPIN
ID1303078Medicare ID - Type Unspecified