Provider Demographics
NPI:1962027433
Name:CONVERGENCE CHIROPRACTIC COMPANY
Entity Type:Organization
Organization Name:CONVERGENCE CHIROPRACTIC COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRANT
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS
Authorized Official - Phone:505-504-2174
Mailing Address - Street 1:404 E PARKCENTER BLVD STE 170
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-7564
Mailing Address - Country:US
Mailing Address - Phone:505-504-2174
Mailing Address - Fax:
Practice Address - Street 1:404 E PARKCENTER BLVD STE 170
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-7564
Practice Address - Country:US
Practice Address - Phone:505-504-2174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty