Provider Demographics
NPI:1508993189
Name:CHUBBUCK CHIROPRACTIC PA
Entity Type:Organization
Organization Name:CHUBBUCK CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-637-8800
Mailing Address - Street 1:445 W CHUBBUCK RD
Mailing Address - Street 2:STE A
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-2308
Mailing Address - Country:US
Mailing Address - Phone:208-637-8800
Mailing Address - Fax:
Practice Address - Street 1:445 W CHUBBUCK RD
Practice Address - Street 2:STE A
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-2308
Practice Address - Country:US
Practice Address - Phone:208-637-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty