Provider Demographics
NPI:1164675740
Name:TOTAL WELLNESS CHIROPRACTIC AND HOLISTIC CARE
Entity Type:Organization
Organization Name:TOTAL WELLNESS CHIROPRACTIC AND HOLISTIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-414-3333
Mailing Address - Street 1:343 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEISER
Mailing Address - State:ID
Mailing Address - Zip Code:83672-2515
Mailing Address - Country:US
Mailing Address - Phone:208-414-3333
Mailing Address - Fax:
Practice Address - Street 1:343 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WEISER
Practice Address - State:ID
Practice Address - Zip Code:83672-2515
Practice Address - Country:US
Practice Address - Phone:208-414-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOTAL WELLNESS CHIROPRACTIC AND HOLISTIC CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C9795OtherBLUE CROSS
ID807598100Medicaid
ID807598100Medicaid