Healthcare Provider Details

I. General information

NPI: 1629903034
Provider Name (Legal Business Name): BROOKE RAE KUEBLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

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

845 E FAIRVIEW AVE STE 115
MERIDIAN ID
83642-8048
US

IV. Provider business mailing address

2285 S CHALLENGER LN APT 102
BOISE ID
83705-6713
US

V. Phone/Fax

Practice location:
  • Phone: 208-893-5401
  • Fax: 208-893-5403
Mailing address:
  • Phone: 360-870-2104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3681118
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: