Provider Demographics
NPI:1437273455
Name:CHIROPRACTIC HEALTH CLINIC, P.A.
Entity Type:Organization
Organization Name:CHIROPRACTIC HEALTH CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-321-1500
Mailing Address - Street 1:9161 W BLACK EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1572
Mailing Address - Country:US
Mailing Address - Phone:208-321-1500
Mailing Address - Fax:208-321-8687
Practice Address - Street 1:9161 W BLACK EAGLE DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1572
Practice Address - Country:US
Practice Address - Phone:208-321-1500
Practice Address - Fax:208-321-8687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010145823OtherBLUE SHIELD
IDCHIA590OtherLICENSE NUMBER
IDC9388OtherBLUE CROSS ID
IDCHIA590OtherLICENSE NUMBER
IDU01324Medicare UPIN