Healthcare Provider Details

I. General information

NPI: 1063826535
Provider Name (Legal Business Name): PRICE CHIROPRACTIC CENTER CHARTERED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9508 W FAIRVIEW AVE
BOISE ID
83704-8103
US

IV. Provider business mailing address

9508 W FAIRVIEW AVE
BOISE ID
83704-8103
US

V. Phone/Fax

Practice location:
  • Phone: 208-323-1313
  • Fax: 208-323-1368
Mailing address:
  • Phone: 208-323-1313
  • Fax: 208-323-1368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCHIA-452
License Number StateID

VIII. Authorized Official

Name: TYLER REIDHEAD
Title or Position: OWNER
Credential: D.C.
Phone: 208-323-1313