Provider Demographics
NPI:1245306539
Name:PEASE, JEFFREY BRYAN (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BRYAN
Last Name:PEASE
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 1:2796 W TORANA DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5622
Mailing Address - Country:US
Mailing Address - Phone:208-895-0336
Mailing Address - Fax:
Practice Address - Street 1:8275 NORTHVIEW ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-7131
Practice Address - Country:US
Practice Address - Phone:208-323-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-743111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1673063Medicare ID - Type Unspecified
IDU48445Medicare UPIN