Provider Demographics
NPI:1396834479
Name:ADOLPHSON, STEVEN JENS (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JENS
Last Name:ADOLPHSON
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 1:114 S MAPLE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-0648
Mailing Address - Country:US
Mailing Address - Phone:208-376-2233
Mailing Address - Fax:208-376-2233
Practice Address - Street 1:114 S MAPLE GROVE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-0648
Practice Address - Country:US
Practice Address - Phone:208-376-2233
Practice Address - Fax:208-376-2233
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA636111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010021606OtherBLUE CROSS OF IDAHO