Healthcare Provider Details

I. General information

NPI: 1174517858
Provider Name (Legal Business Name): RICHARD PAUL SAMPSON R.N.,D.C.,F.I.A.M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 N MAIN ST
MERIDIAN ID
83642-1707
US

IV. Provider business mailing address

1504 N MAIN ST
MERIDIAN ID
83642-1707
US

V. Phone/Fax

Practice location:
  • Phone: 208-888-2267
  • Fax: 208-288-0260
Mailing address:
  • Phone: 208-888-2267
  • Fax: 208-288-0260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA 470
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACC-57
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: