Provider Demographics
NPI:1184782963
Name:MCCALL CHIROPRACTIC INC.
Entity type:Organization
Organization Name:MCCALL CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GUY
Authorized Official - Last Name:JEPPE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:208-634-8271
Mailing Address - Street 1:PO BOX 931
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638
Mailing Address - Country:US
Mailing Address - Phone:208-634-8271
Mailing Address - Fax:208-634-8271
Practice Address - Street 1:301 E PARK ST
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-3803
Practice Address - Country:US
Practice Address - Phone:086-348-2712
Practice Address - Fax:208-634-3526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA914111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC1773OtherBLUE CROSS
ID000010028703OtherREGENCE BL SHIELD
ID000010028703OtherREGENCE BL SHIELD