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Idaho Chiropractic Group, Pllc

Chiropractor

Chiropractic Providers

403 S 11th St, Suite #110, Boise, ID 83702-6968

PECOS Enrollment

Based on the most recent information from CMS, provider Idaho Chiropractic Group, Pllc does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1639280712
Provider Type
Organization
Full Name
Idaho Chiropractic Group, Pllc

Subpart
No
Enumeration Date
8/31/2006
Last Updated
8/22/2020

Contact Information

Practice Location

403 S 11th St, Suite #110, Boise, ID 83702-6968

(208) 343-6900

(208) 343-0642

Mailing Location

PO Box 7442, Boise, ID 83707-1442

Unlisted Phone

Unlisted Fax

Authorized Official

Careaga, Julie (Billing Manager)

(208) 343-6900

Provider Taxonomies

Code	Description	License
Code 111N00000X Primary	Description Chiropractor Chiropractic Providers	License CHIA-559 Idaho
Code 111N00000X	Description Chiropractor Chiropractic Providers	License CHIA-802 Idaho

Provider Identifiers

ID	Description	Issuer
ID C1526	Description Other	Issuer BLUE CROSS Idaho
ID 000010027629	Description Other	Issuer BLUE SHIELD Idaho

Idaho Chiropractic Group, Pllc

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Anacker, Jennifer Lynn

Rosenberg Chiropractic

Blevins, Kyle

Sartin, Cory Michael

Personal Care Chiropractic Clinics P A

Lacoursiere, Henry Neil

Thomson, Carlee D

Asla, Nicolas

Anacker Clinic Of Chiropractic, P.C.

Rosenberg, James R