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General NPI Number Information
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NPI Number | 1437877321
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Entity Type | Organization
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Legal Business Name | DR. MICHAEL D. RAE, DC, PLLC
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Dates
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Enumeration Date | 08/17/2022
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 1843 S BROADWAY AVE STE 203A
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City | BOISE
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State | ID
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Zip | 83706-3862
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Country | US
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Telephone | 208-985-3233
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Fax |
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Provider Business Mailing Address
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Address Line | 1729 S GRANT AVE
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City | BOISE
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State | ID
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Zip | 83706-3529
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Country | US
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Telephone | 208-985-3233
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Fax |
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Authorized Official
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Title or Position | OWNER/ CHIROPRACTOR
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Name | DR. MICHAEL D RAE
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Credential | DC
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Telephone | 208-985-3233
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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 |
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License Number State |
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