Provider Demographics
NPI:1861672446
Name:JEPPE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:JEPPE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:JEPPE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-378-1190
Mailing Address - Street 1:4491 N DRESDEN PL STE 3
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83714-1391
Mailing Address - Country:US
Mailing Address - Phone:208-378-1190
Mailing Address - Fax:208-323-6508
Practice Address - Street 1:4491 N DRESDEN PL STE 3
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83714-1391
Practice Address - Country:US
Practice Address - Phone:208-378-1190
Practice Address - Fax:208-323-6508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty