Provider Demographics
NPI:1669518791
Name:SOULSBY, HAROLD EUGENE (DC)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:EUGENE
Last Name:SOULSBY
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 1:1246 OAKLEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318
Mailing Address - Country:US
Mailing Address - Phone:208-678-3893
Mailing Address - Fax:208-678-7374
Practice Address - Street 1:1246 OAKLEY AVENUE
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318
Practice Address - Country:US
Practice Address - Phone:208-678-3893
Practice Address - Fax:208-678-7374
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDC321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC3217OtherBLUE CROSS
ID000010008029OtherREGENCE BLUE SHIELD
IDC3217OtherBLUE CROSS
T44421Medicare UPIN