MEDICARE: ASPEN CHIROPRACTIC, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CHIA-1293	ID

General Provider Information

NPI Number	:	1205093408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPEN CHIROPRACTIC, PC

Provider Business Mailing Address
First Line	:	1508 W CAYUSE CREEK DR
Second Line	:	SUITE 100
City	:	MERIDIAN
State	:	ID
Zip	:	83646-4795
Country	:	US
Telephone Number	:	208-898-1382
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 W CAYUSE CREEK DR
Second Line	:	SUITE 100
City	:	MERIDIAN
State	:	ID
Zip	:	83646-4795
Country	:	US
Telephone Number	:	208-898-1382
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. JASON CHARLES LEE
Credential	:	DC
Telephone Number	:	208-841-4733

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	05/16/2008

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