Provider Demographics
NPI:1558472365
Name:STRAWN, DAVID MITCHELL (DC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MITCHELL
Last Name:STRAWN
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 1:6013 WEST OVERLAND RD
Mailing Address - Street 2:STE 103
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709
Mailing Address - Country:US
Mailing Address - Phone:208-344-5880
Mailing Address - Fax:208-377-4131
Practice Address - Street 1:6013 WEST OVERLAND RD
Practice Address - Street 2:STE 103
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709
Practice Address - Country:US
Practice Address - Phone:208-344-5880
Practice Address - Fax:208-377-4131
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-820111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1673584Medicare ID - Type Unspecified
U65604Medicare UPIN