1487065397 NPI number — SCHRECK CHIROPRACTIC AND WELLNESS

Table of content: CHRISTON ESLINGER PTA, CMT (NPI 1912404419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487065397 NPI number — SCHRECK CHIROPRACTIC AND WELLNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHRECK CHIROPRACTIC AND WELLNESS
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:
1487065397
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 S WASHINGTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EMMETT
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83617-3526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-365-1392
Provider Business Mailing Address Fax Number:
208-365-4950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 S WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMMETT
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83617-3526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-365-1392
Provider Business Practice Location Address Fax Number:
208-365-4950
Provider Enumeration Date:
05/13/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SCHRECK
Authorized Official First Name:
JASON
Authorized Official Middle Name:
CHIRSTOPHER
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
208-365-1392

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CHIA1512 , 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)





Copyright © 2007-2026 www.npivalidator.com