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General NPI Number Information
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NPI Number | 1760261739
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Entity Type | Individual
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Provider Name | JON CHARLES JUKER DC
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Gender | Male
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Dates
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Enumeration Date | 09/27/2023
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 1390 S MAPLE GROVE RD UNIT 200
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City | BOISE
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State | ID
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Zip | 83709-1610
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Country | US
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Telephone | 208-986-0966
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Fax |
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Provider Business Mailing Address
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Address Line | 614 S LAWRENCE AVE
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City | BOISE
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State | ID
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Zip | 83709-0827
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Country | US
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Telephone | 208-908-9758
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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-2372
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License Number State | ID
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