Provider Demographics
NPI:1316206857
Name:WI CARE
Entity Type:Organization
Organization Name:WI CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HUMPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-440-7773
Mailing Address - Street 1:2447 S APPLE ST
Mailing Address - Street 2:SUITE #102
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-5169
Mailing Address - Country:US
Mailing Address - Phone:208-440-7773
Mailing Address - Fax:
Practice Address - Street 1:2447 S APPLE ST
Practice Address - Street 2:SUITE #102
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-5169
Practice Address - Country:US
Practice Address - Phone:208-440-7773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1496111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty