Provider Demographics
NPI:1114127149
Name:ANACKER CLINIC OF CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:ANACKER CLINIC OF CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ANACKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-287-2299
Mailing Address - Street 1:PO BOX 2663
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83701-2663
Mailing Address - Country:US
Mailing Address - Phone:208-287-2299
Mailing Address - Fax:208-287-2298
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7700
Practice Address - Country:US
Practice Address - Phone:208-287-2299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-997111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1378832OtherMEDICARE GROUP
ID1674929OtherMEDICARE INDIVIDUAL
ID1378832OtherMEDICARE GROUP