Healthcare Provider Details

I. General information

NPI: 1194768705
Provider Name (Legal Business Name): PARTO PAYAMI D.C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 N. ORCHARD ST.
BOISE ID
83706
US

IV. Provider business mailing address

8051 W. BURNTREE CT.
BOISE ID
83704-0721
US

V. Phone/Fax

Practice location:
  • Phone: 208-376-3113
  • Fax: 208-376-4114
Mailing address:
  • Phone: 208-376-3113
  • Fax: 208-376-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA-873
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: