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General NPI Number Information
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NPI Number | 1245306539
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Entity Type | Individual
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Provider Name | JEFFREY BRYAN PEASE D.C.
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Gender | Male
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 04/11/2013
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Provider Practice Location Address
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Address Line | 8275 NORTHVIEW ST
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City | BOISE
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State | ID
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Zip | 83704-7131
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Country | US
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Telephone | 208-323-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 2796 W TORANA DR
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City | MERIDIAN
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State | ID
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Zip | 83642-5622
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Country | US
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Telephone | 208-895-0336
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Fax |
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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 | CHIA-743
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License Number State | ID
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