Provider Demographics
NPI:1750670824
Name:ELEVATION CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:ELEVATION CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:L
Authorized Official - Last Name:COUCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-287-9393
Mailing Address - Street 1:10451 W GARVERDALE CT STE 204
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5475
Mailing Address - Country:US
Mailing Address - Phone:208-287-9393
Mailing Address - Fax:208-287-9394
Practice Address - Street 1:10451 W GARVERDALE CT STE 204
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5475
Practice Address - Country:US
Practice Address - Phone:208-287-9393
Practice Address - Fax:208-287-9394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDCHIA-1451OtherINDIVIDUAL NPI 1518280890