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General NPI Number Information
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NPI Number | 1003185265
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Entity Type | Individual
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Provider Name | JACALYN RENAE AMRINE D.C.
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Gender | Female
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Dates
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Enumeration Date | 12/17/2011
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 435 E SHORE DR STE 130
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City | EAGLE
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State | ID
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Zip | 83616-5754
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Country | US
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Telephone | 208-917-1929
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Fax | 208-485-9629
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Provider Business Mailing Address
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Address Line | 435 E SHORE DR STE 130
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City | EAGLE
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State | ID
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Zip | 83616-5754
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Country | US
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Telephone | 208-917-1929
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Fax | 208-485-9629
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 32089
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIA-1930
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License Number State | ID
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