Provider Demographics
NPI:1669782967
Name:STOREY CHIROPRACTIC CLINIC PC
Entity type:Organization
Organization Name:STOREY CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:STOREY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-345-2211
Mailing Address - Street 1:50 S BROADWAY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-7283
Mailing Address - Country:US
Mailing Address - Phone:208-345-2211
Mailing Address - Fax:208-345-2097
Practice Address - Street 1:50 S BROADWAY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7283
Practice Address - Country:US
Practice Address - Phone:208-345-2211
Practice Address - Fax:208-345-2097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA 554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty