Provider Demographics
NPI:1003185265
Name:AMRINE, JACALYN RENAE (DC)
Entity type:Individual
Prefix:DR
First Name:JACALYN
Middle Name:RENAE
Last Name:AMRINE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JACALYN
Other - Middle Name:RENAE
Other - Last Name:MAROSSY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:435 E SHORE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-5754
Mailing Address - Country:US
Mailing Address - Phone:208-917-1929
Mailing Address - Fax:208-485-9629
Practice Address - Street 1:435 E SHORE DR STE 130
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-5754
Practice Address - Country:US
Practice Address - Phone:208-917-1929
Practice Address - Fax:208-485-9629
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-17
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32089111N00000X
IDCHIA-1930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor