Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | C622 | ID |
Y | 207R00000X | Internist | CHIA622 | ID |
Y | 111NI0900X | Internist | CHIA622 | ID |
N | 111NN1001X | Nutrition | CHIA622 | ID |
N | 111NP0017X | Pediatric Chiropractor | CHIA622 | ID |
N | 111NS0005X | Chiropractic Sports Physician | CHIA622 | ID |
NPI | 1962542332 |
---|---|
Provider Name | Dr. Maria M Maricich |
First Address | Ketchum, ID 83340 |
Second Address | Ketchum, ID 83340 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 25/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000-1002-0870 | BLUE SHEILD (01) | ID |
C622-8 | BLUE CROSS (01) | ID |