Healthcare Provider Details

I. General information

NPI: 1487589057
Provider Name (Legal Business Name): DOT PHYSICALS BOISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2596 N STOKESBERRY PL STE 130
MERIDIAN ID
83646-6087
US

IV. Provider business mailing address

2596 N STOKESBERRY PL STE 130
MERIDIAN ID
83646-6087
US

V. Phone/Fax

Practice location:
  • Phone: 208-283-2876
  • Fax:
Mailing address:
  • Phone: 208-283-2876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: OMAR ANGUIANO
Title or Position: CEO
Credential: DC
Phone: 619-397-8926