Provider Demographics
NPI:1932508272
Name:HENZE, RONALD III (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:HENZE
Suffix:III
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 1:13999 W WAINWRIGHT DR STE 201
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1969
Mailing Address - Country:US
Mailing Address - Phone:208-939-0775
Mailing Address - Fax:208-575-6114
Practice Address - Street 1:13999 W WAINWRIGHT DR STE 201
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-1969
Practice Address - Country:US
Practice Address - Phone:208-939-0775
Practice Address - Fax:208-575-6114
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA1614111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDIDTPID012211Medicaid