Provider Demographics
NPI:1942505896
Name:BERRETT, NATHAN T (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:T
Last Name:BERRETT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:13900 W WAINWRIGHT DR
Mailing Address - Street 2:STE 103
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-5028
Mailing Address - Country:US
Mailing Address - Phone:208-376-0660
Mailing Address - Fax:208-621-2717
Practice Address - Street 1:13900 W WAINWRIGHT DR
Practice Address - Street 2:STE 103
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5028
Practice Address - Country:US
Practice Address - Phone:208-376-0660
Practice Address - Fax:208-621-2717
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor