Provider Demographics
NPI:1386675742
Name:ROBISON CHIROPRACTIC PC
Entity Type:Organization
Organization Name:ROBISON CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ROBISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-936-4463
Mailing Address - Street 1:1511 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-4307
Mailing Address - Country:US
Mailing Address - Phone:208-936-4463
Mailing Address - Fax:208-936-4468
Practice Address - Street 1:1511 3RD ST S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4307
Practice Address - Country:US
Practice Address - Phone:208-936-4463
Practice Address - Fax:208-936-4468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1675083OtherMEDICARE
ID806406800Medicaid
ID1619966140OtherINDIVIDUAL NPI
ID806406800Medicaid