Provider Demographics
NPI:1609608298
Name:BEN INDIEK PLLC
Entity type:Organization
Organization Name:BEN INDIEK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:INDIEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-608-8990
Mailing Address - Street 1:12022 W ARDYCE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-5522
Mailing Address - Country:US
Mailing Address - Phone:208-608-8990
Mailing Address - Fax:
Practice Address - Street 1:3120 W BELLTOWER DR STE 150
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-7700
Practice Address - Country:US
Practice Address - Phone:208-846-8898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty