Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | CHIA-1166 | ID |
NPI | 1285658302 |
---|---|
Provider Name | Dr. Blake Louis Howard |
First Address | Boise, ID 83703-3463 |
Second Address | Boise, ID 83713-1067 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/07/2007 |