Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIA-1794 | ID |
NPI | 1003335431 |
---|---|
Provider Name | Dr. Benjamin Webb |
First Address | Meridian, ID 83642-8208 |
Second Address | Boise, ID 83713-1969 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2017 |
Last Update Date | 18/09/2017 |