Provider Demographics
NPI:1760671747
Name:VISTA CHIROPRACTIC
Entity Type:Organization
Organization Name:VISTA CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHULER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-336-4040
Mailing Address - Street 1:1805 OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-3143
Mailing Address - Country:US
Mailing Address - Phone:208-336-4040
Mailing Address - Fax:
Practice Address - Street 1:1805 OVERLAND
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-3143
Practice Address - Country:US
Practice Address - Phone:208-336-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1373424Medicare PIN