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General NPI Number Information
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NPI Number | 1861672446
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Entity Type | Organization
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Legal Business Name | JEPPE CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 11/12/2007
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Last Update Date | 11/12/2007
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Provider Practice Location Address
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Address Line | 4491 N DRESDEN PL STE 3
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City | GARDEN CITY
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State | ID
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Zip | 83714-1391
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Country | US
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Telephone | 208-378-1190
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Fax | 208-323-6508
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Provider Business Mailing Address
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Address Line | 4491 N DRESDEN PL STE 3
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City | GARDEN CITY
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State | ID
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Zip | 83714-1391
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Country | US
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Telephone | 208-378-1190
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Fax | 208-323-6508
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | BENJAMIN E JEPPE
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Credential | D.C.
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Telephone | 208-378-1190
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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-1048
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License Number State | ID
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