Provider Demographics
NPI:1619966140
Name:ROBISON, WILLIAM PAUL (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PAUL
Last Name:ROBISON
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 1:1511 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-4307
Mailing Address - Country:US
Mailing Address - Phone:208-936-4463
Mailing Address - Fax:208-936-4468
Practice Address - Street 1:1511 3RD ST S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4307
Practice Address - Country:US
Practice Address - Phone:208-936-4463
Practice Address - Fax:208-936-4468
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-1040111N00000X
IDCHIA-1000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1369362OtherGROUP PTIN
IDC5610OtherBLUE CROSS
ID806406800Medicaid
ID1386675742OtherGROUP NPI
IDC5610OtherBLUE CROSS
ID806406800Medicaid