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General NPI Number Information
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NPI Number | 1205093408
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Entity Type | Organization
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Legal Business Name | ASPEN CHIROPRACTIC, PC
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Dates
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Enumeration Date | 05/16/2008
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 1508 W CAYUSE CREEK DR SUITE 100
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City | MERIDIAN
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State | ID
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Zip | 83646-4795
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Country | US
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Telephone | 208-898-1382
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Fax |
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Provider Business Mailing Address
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Address Line | 1508 W CAYUSE CREEK DR SUITE 100
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City | MERIDIAN
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State | ID
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Zip | 83646-4795
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Country | US
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Telephone | 208-898-1382
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JASON CHARLES LEE
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Credential | DC
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Telephone | 208-841-4733
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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 | CHIA-1293
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License Number State | ID
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