Healthcare Provider Details

I. General information

NPI: 1396982567
Provider Name (Legal Business Name): OGATA CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5418 N EAGLE RD SUITE 120
BOISE ID
83713-0998
US

IV. Provider business mailing address

5418 N EAGLE RD SUITE 120
BOISE ID
83713-0998
US

V. Phone/Fax

Practice location:
  • Phone: 208-938-3334
  • Fax: 208-938-3335
Mailing address:
  • Phone: 208-938-3334
  • Fax: 208-938-3335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA920
License Number StateID

VIII. Authorized Official

Name: TY OGATA
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 208-938-3334