Provider Demographics
NPI:1982147443
Name:PICKMAN CHIROPRACTIC
Entity Type:Organization
Organization Name:PICKMAN CHIROPRACTIC
Other - Org Name:GONSTEAD SPINE AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:MCQUILKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-888-6077
Mailing Address - Street 1:3085 E MAGIC VIEW DR STE 180
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-3757
Mailing Address - Country:US
Mailing Address - Phone:208-888-6077
Mailing Address - Fax:888-447-1415
Practice Address - Street 1:3085 E MAGIC VIEW DR STE 180
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-3757
Practice Address - Country:US
Practice Address - Phone:208-888-6077
Practice Address - Fax:888-447-1415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty