Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIA-1516 | ID |
NPI | 1013018282 |
---|---|
Provider Name | Todd Steven Pickman |
First Address | Meridian, ID 83642-3745 |
Second Address | Meridian, ID 83642 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 28/05/2018 |