Boise Sports Chiropractic Clinic
Chiropractor, Orthopedic in Boise, ID. Organization (NPI-2).
NPI number1114124138
StatusActive
Last updated in NPPESSep 11, 2025
Details
- NPI
- 1114124138
- Entity type
- Organization (NPI-2)
- Legal business name
- Boise Sports Chiropractic Clinic
- Organization subpart
- No
- Enumeration date
- Jul 2, 2007
- Last updated
- Sep 11, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 111NX0800X | Chiropractor, Orthopedic | C-4918 | ID | Yes |
| 111NN1001X | Chiropractor, Nutrition | C-4918 | ID | |
| 111NR0400X | Chiropractor, Rehabilitation | C-4918 | ID | |
| 111N00000X | Chiropractor | C-4918 | ID | |
| 111NS0005X | Chiropractor, Sports Physician | C-4918 | ID |
Practice location
3314 N Cole RdBoise, ID 83704-4403
Phone 208-377-9930
Mailing address
3314 N Cole RdBoise, ID 83704-4403
Authorized official
Kevin Hearon
Owner
2083779930
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