Provider Demographics
NPI:1811183023
Name:IDEAL HEALTH
Entity type:Organization
Organization Name:IDEAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:W
Authorized Official - Last Name:BETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-830-3034
Mailing Address - Street 1:8505 W OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1644
Mailing Address - Country:US
Mailing Address - Phone:208-629-1904
Mailing Address - Fax:208-545-1846
Practice Address - Street 1:8631 W ARDENE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-2601
Practice Address - Country:US
Practice Address - Phone:208-629-1904
Practice Address - Fax:208-545-1846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2023-08-31
Deactivation Date:2023-08-07
Deactivation Code:
Reactivation Date:2023-08-31
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-977111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8078217Medicaid
ID8078217Medicaid