Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NP0017X | Pediatric Chiropractor | CHIA-2013 | ID |
Y | 111NP0017X | Pediatric Chiropractor | CHIA-2103 | ID |
NPI | 1083208862 |
---|---|
Provider Name | Christine Nguyen |
First Address | Caldwell, ID 83605-7549 |
Second Address | Boise, ID 83709-1644 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2021 |
Last Update Date | 23/02/2021 |