Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIA-535 | ID |
NPI | 1003982471 |
---|---|
Provider Name | Dr. Fredric Charles Hill I |
First Address | Blackfoot, ID 83221-1970 |
Second Address | Blackfoot, ID 83221-1970 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CHIA-535 | STATE LICENSE (01) | ID |
T81750 | (02) | ID |