Provider Demographics
NPI:1023588019
Name:FIELD, SAMUEL TANNER (DC)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:TANNER
Last Name:FIELD
Suffix:
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 1:1601 12TH AVE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686
Mailing Address - Country:US
Mailing Address - Phone:208-466-0200
Mailing Address - Fax:208-648-4080
Practice Address - Street 1:1601 12TH AVE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686
Practice Address - Country:US
Practice Address - Phone:208-466-0200
Practice Address - Fax:208-648-4080
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5952111N00000X
IDCH1A2081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor