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General NPI Number Information
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NPI Number | 1316206857
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Entity Type | Organization
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Legal Business Name | WI CARE
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Dates
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Enumeration Date | 05/03/2012
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Last Update Date | 05/03/2012
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Provider Practice Location Address
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Address Line | 2447 S APPLE ST SUITE #102
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City | BOISE
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State | ID
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Zip | 83706-5169
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Country | US
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Telephone | 208-440-7773
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Fax |
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Provider Business Mailing Address
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Address Line | 2447 S APPLE ST SUITE #102
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City | BOISE
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State | ID
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Zip | 83706-5169
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Country | US
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Telephone | 208-440-7773
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BENJAMIN PAUL HUMPHREY
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Credential | D.C.
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Telephone | 208-440-7773
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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-1496
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License Number State | ID
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