Provider Demographics
NPI:1235335142
Name:GARCIA, PAUL JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JOSEPH
Last Name:GARCIA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 W EVEREST LN
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-7033
Mailing Address - Country:US
Mailing Address - Phone:208-343-2770
Mailing Address - Fax:
Practice Address - Street 1:2122 W EVEREST LN
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-7033
Practice Address - Country:US
Practice Address - Phone:208-343-2770
Practice Address - Fax:208-888-1097
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor