Provider Demographics
NPI:1295862662
Name:WAITE, ALAN LEO (DC)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:LEO
Last Name:WAITE
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 1:54 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:WEISER
Mailing Address - State:ID
Mailing Address - Zip Code:83672-1941
Mailing Address - Country:US
Mailing Address - Phone:208-414-3881
Mailing Address - Fax:208-414-3882
Practice Address - Street 1:54 W COURT ST
Practice Address - Street 2:
Practice Address - City:WEISER
Practice Address - State:ID
Practice Address - Zip Code:83672-1941
Practice Address - Country:US
Practice Address - Phone:208-414-3881
Practice Address - Fax:208-414-3882
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-437111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC437-1OtherBLUE CROSS IDAHO
IDC437-1OtherBLUE CROSS IDAHO