Provider Demographics
NPI:1942982822
Name:INDIAN CREEK CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:INDIAN CREEK CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-949-5347
Mailing Address - Street 1:2523 S 10TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-6760
Mailing Address - Country:US
Mailing Address - Phone:208-649-4321
Mailing Address - Fax:
Practice Address - Street 1:2523 S 10TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-6760
Practice Address - Country:US
Practice Address - Phone:208-649-4321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty