Provider Demographics
NPI:1073721296
Name:PAYETTE CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:PAYETTE CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:HARSH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-642-9096
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:PAYETTE
Mailing Address - State:ID
Mailing Address - Zip Code:83661-0001
Mailing Address - Country:US
Mailing Address - Phone:208-642-9096
Mailing Address - Fax:
Practice Address - Street 1:200 N 9TH ST
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-2530
Practice Address - Country:US
Practice Address - Phone:208-642-9096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDC456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty