Provider Demographics
NPI:1891821369
Name:NAVE, MIKEAL BRUCE (DC)
Entity Type:Individual
Prefix:
First Name:MIKEAL
Middle Name:BRUCE
Last Name:NAVE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-3536
Mailing Address - Country:US
Mailing Address - Phone:208-365-6300
Mailing Address - Fax:208-365-6309
Practice Address - Street 1:108 E 6TH ST
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-3536
Practice Address - Country:US
Practice Address - Phone:208-365-6300
Practice Address - Fax:208-365-6309
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15672111N00000X
IDCHIA-1417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0156720OtherBLUE SHIELD BLUE CORSS
CADC0156720OtherBLUE SHIELD BLUE CORSS
CADC0156720OtherBLUE SHIELD BLUE CORSS
CA330202329OtherTAX ID NUMBER