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General NPI Number Information
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NPI Number | 1215972005
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Entity Type | Organization
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Legal Business Name | ROSENBERG CHIROPRACTIC
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 09/16/2008
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Provider Practice Location Address
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Address Line | 1150 W STATE ST SUITE 220
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City | BOISE
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State | ID
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Zip | 83702-5327
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Country | US
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Telephone | 208-384-9070
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Fax | 208-384-9057
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Provider Business Mailing Address
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Address Line | 1150 W STATE ST SUITE 220
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City | BOISE
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State | ID
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Zip | 83702-5327
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Country | US
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Telephone | 208-384-9070
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Fax | 208-384-9057
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | JAMES R ROSENBERG
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Credential | DC
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Telephone | 208-384-9070
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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 | CHIA1058
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License Number State | ID
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