Provider Demographics
NPI:1881642312
Name:SPAINHOWER, TOD (DC)
Entity Type:Individual
Prefix:DR
First Name:TOD
Middle Name:
Last Name:SPAINHOWER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JERRY
Other - Middle Name:TOD
Other - Last Name:SPAINHOWER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:9217 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-1737
Mailing Address - Country:US
Mailing Address - Phone:208-853-7221
Mailing Address - Fax:208-853-5518
Practice Address - Street 1:9217 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-1737
Practice Address - Country:US
Practice Address - Phone:208-853-7221
Practice Address - Fax:208-853-5518
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA 586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010019821OtherREGENCE BLUESHIELD OF ID
IDCHIA 586OtherIDAHO LICENSE
IDT92926Medicare UPIN
ID000010019821OtherREGENCE BLUESHIELD OF ID
IDCHIA 586OtherIDAHO LICENSE