Provider Demographics
NPI:1356358204
Name:GAERTNER CHIROPRACTIC & INTEGRATED MEDICINE CLINIC PA
Entity type:Organization
Organization Name:GAERTNER CHIROPRACTIC & INTEGRATED MEDICINE CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:D
Authorized Official - Last Name:GAERTNER-EWING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-467-5994
Mailing Address - Street 1:315 7TH AVE S
Mailing Address - Street 2:PO BOX 3306
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-3848
Mailing Address - Country:US
Mailing Address - Phone:208-467-5994
Mailing Address - Fax:
Practice Address - Street 1:217 W GEORGIA AVE STE 120
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6812
Practice Address - Country:US
Practice Address - Phone:208-467-5994
Practice Address - Fax:208-467-5127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA829111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1673572Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
ID1375037Medicare PIN