Provider Demographics
NPI:1508185752
Name:CHIROPRACTIC DIFFERENCE, PA
Entity Type:Organization
Organization Name:CHIROPRACTIC DIFFERENCE, PA
Other - Org Name:THE CHIROPRACTIC DIFFERENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-461-6523
Mailing Address - Street 1:924 3RD ST S
Mailing Address - Street 2:SUITE A
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-3817
Mailing Address - Country:US
Mailing Address - Phone:208-461-6523
Mailing Address - Fax:208-461-9130
Practice Address - Street 1:924 3RD ST S
Practice Address - Street 2:SUITE A
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3817
Practice Address - Country:US
Practice Address - Phone:208-461-6523
Practice Address - Fax:208-461-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA879111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDU79468Medicare UPIN