Healthcare Provider Details

I. General information

NPI: 1225230972
Provider Name (Legal Business Name): KEVIN G HEARON D.C., C.C.S.P
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3314 N COLE RD
BOISE ID
83704-4403
US

IV. Provider business mailing address

3425 ARMOR ST
BOISE ID
83704-4506
US

V. Phone/Fax

Practice location:
  • Phone: 208-337-9930
  • Fax:
Mailing address:
  • Phone: 208-377-9930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHI-491
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHI-491
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: