Provider Demographics
NPI:1447694401
Name:COMPLETE CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:COMPLETE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-678-2629
Mailing Address - Street 1:1635 OVERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-2433
Mailing Address - Country:US
Mailing Address - Phone:208-678-2629
Mailing Address - Fax:208-678-2697
Practice Address - Street 1:1635 OVERLAND AVE
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-2433
Practice Address - Country:US
Practice Address - Phone:208-678-2629
Practice Address - Fax:208-678-2697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1231111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC5663OtherBLUE CROSS OF IDAHO PROVIDER NUMBER
ID000010160551OtherBLUE SHIELD OF IDAHO PROVIDER ID NUMBER
ID1672871Medicare PIN