Provider Demographics
NPI:1679854491
Name:STREAMLINE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:STREAMLINE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-637-2225
Mailing Address - Street 1:246 E CHUBBUCK RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-1965
Mailing Address - Country:US
Mailing Address - Phone:208-637-2225
Mailing Address - Fax:208-637-2226
Practice Address - Street 1:246 E CHUBBUCK RD
Practice Address - Street 2:SUITE A
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-1965
Practice Address - Country:US
Practice Address - Phone:208-637-2225
Practice Address - Fax:208-637-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA1473111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty