Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CHIA-629 | ID |
NPI | 1447250444 |
---|---|
Provider Name | Dr. Martha Jenkins |
First Address | Boise, ID 83705 |
Second Address | Boise, ID 83705-2845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000010019263 | BLUE SHIELD PIN (01) | ID |
C3704 | BLUE CROSS PIN (01) | ID |
T17866 | (02) | ID |