Provider Demographics
NPI:1073776654
Name:NALBONE FAMILY CHIROPRACTIC AND WELLNESS, LLC
Entity Type:Organization
Organization Name:NALBONE FAMILY CHIROPRACTIC AND WELLNESS, LLC
Other - Org Name:DOCTOR JOE'S CHIROPRACTIC CENTER, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:NALBONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-908-6111
Mailing Address - Street 1:7227 POTOMAC DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9150
Mailing Address - Country:US
Mailing Address - Phone:208-908-6111
Mailing Address - Fax:208-908-6112
Practice Address - Street 1:7227 POTOMAC DRIVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9150
Practice Address - Country:US
Practice Address - Phone:208-908-6111
Practice Address - Fax:208-908-6112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
V05308Medicare UPIN
802095Medicare PIN