1841451267 NPI number — RABIN CLINIC OF CHIROPRACTIC, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841451267 NPI number — RABIN CLINIC OF CHIROPRACTIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RABIN CLINIC OF CHIROPRACTIC, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841451267
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1009 N 11TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOISE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83702-4142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-890-6010
Provider Business Mailing Address Fax Number:
208-388-1996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1080 W BOISE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83706-3502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-388-1895
Provider Business Practice Location Address Fax Number:
208-388-1996
Provider Enumeration Date:
06/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RABIN
Authorized Official First Name:
EDWIN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
208-890-6010

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CHIA-1003 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 807802800 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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