Provider Demographics
NPI:1518022490
Name:SARAH WOLVERTON
Entity Type:Organization
Organization Name:SARAH WOLVERTON
Other - Org Name:WOLVERTON CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-871-7077
Mailing Address - Street 1:2999 N LAKEHARBOR LN
Mailing Address - Street 2:STE. 201
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-6275
Mailing Address - Country:US
Mailing Address - Phone:208-853-2277
Mailing Address - Fax:208-853-2278
Practice Address - Street 1:1416 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702
Practice Address - Country:US
Practice Address - Phone:208-906-1485
Practice Address - Fax:208-906-1489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA1127111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty