Healthcare Provider Details

I. General information

NPI: 1932280690
Provider Name (Legal Business Name): PAUL LOUIS BATTAGLIA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 W PRAIRIE SHOPPING CTR
HAYDEN ID
83835-9854
US

IV. Provider business mailing address

77 W PRAIRIE SHOPPING CTR
HAYDEN ID
83835-9854
US

V. Phone/Fax

Practice location:
  • Phone: 208-762-3560
  • Fax:
Mailing address:
  • Phone: 208-762-3560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00667800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number8762
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: