Provider Demographics
NPI:1265633192
Name:RESTAD, JULIE LEE (DC)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:LEE
Last Name:RESTAD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:ID
Mailing Address - Zip Code:83644-5270
Mailing Address - Country:US
Mailing Address - Phone:208-402-8002
Mailing Address - Fax:
Practice Address - Street 1:1012 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:ID
Practice Address - Zip Code:83644-5270
Practice Address - Country:US
Practice Address - Phone:208-402-8002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29715111N00000X
IDCHIA-2135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV09049Medicare UPIN
CADC297150Medicare ID - Type Unspecified