Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NP0017X | Pediatric Chiropractor | CHIA-2006 | ID |
NPI | 1891380093 |
---|---|
Provider Name | Dr. Karly Rodriguez |
First Address | Boise, ID 83709-2505 |
Second Address | Boise, ID 83709-2505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2021 |
Last Update Date | 09/03/2021 |