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General NPI Number Information
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NPI Number | 1396982567
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Entity Type | Organization
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Legal Business Name | OGATA CHIROPRACTIC INC
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Dates
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Enumeration Date | 01/09/2009
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Last Update Date | 01/09/2009
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Provider Practice Location Address
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Address Line | 5418 N EAGLE RD SUITE 120
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City | BOISE
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State | ID
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Zip | 83713-0998
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Country | US
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Telephone | 208-938-3334
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Fax | 208-938-3335
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Provider Business Mailing Address
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Address Line | 5418 N EAGLE RD SUITE 120
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City | BOISE
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State | ID
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Zip | 83713-0998
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Country | US
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Telephone | 208-938-3334
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Fax | 208-938-3335
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | TY OGATA
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Credential | DC
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Telephone | 208-938-3334
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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 | CHIA920
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License Number State | ID
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