Healthcare Provider Details

I. General information

NPI: 1720377633
Provider Name (Legal Business Name): MICHAEL TODD DAGLEN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5246 N EAGLE RD
BOISE ID
83713-0945
US

IV. Provider business mailing address

16080 HORIZON DR
CALDWELL ID
83607-8298
US

V. Phone/Fax

Practice location:
  • Phone: 208-939-3000
  • Fax:
Mailing address:
  • Phone: 541-554-6658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA-1978
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: