Provider Demographics
NPI:1710288865
Name:SAMS CHIROPRACTIC
Entity Type:Organization
Organization Name:SAMS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:SAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-888-7242
Mailing Address - Street 1:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83680-0837
Mailing Address - Country:US
Mailing Address - Phone:208-888-7242
Mailing Address - Fax:208-888-7263
Practice Address - Street 1:1900 N LAKES PL
Practice Address - Street 2:SUITE 100
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6231
Practice Address - Country:US
Practice Address - Phone:208-888-7242
Practice Address - Fax:208-888-7263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA410111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty