Provider Demographics
NPI:1164849949
Name:ALL AMERICAN CHIROPRACTIC HEALTH CENTER
Entity Type:Organization
Organization Name:ALL AMERICAN CHIROPRACTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-232-7558
Mailing Address - Street 1:115 S. 15TH, SUITE C
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4068
Mailing Address - Country:US
Mailing Address - Phone:208-232-7558
Mailing Address - Fax:208-232-7549
Practice Address - Street 1:115 S. 15TH, SUITE C
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4068
Practice Address - Country:US
Practice Address - Phone:208-232-7558
Practice Address - Fax:208-232-7549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP00410313OtherRR PTAN
ID8056219Medicaid
ID20004656Medicare UPIN
ID2004656Medicare UPIN
IDP00410313OtherRR PTAN