| Eagle Chiropractic PC | |
|
5337 S State St Eagle ID 83616-4313 | |
| (208) 939-9195 | |
| (208) 939-4686 |
| Full Name | Eagle Chiropractic PC |
|---|---|
| Speciality | Clinic/Center |
| Location | 5337 S State St, Eagle, Idaho |
| Authorized Official Name and Position | Sherry Lynn Nord (SECRETARY) |
| Authorized Official Contact | 2089399195 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eagle Chiropractic PC 5337 W State St Eagle ID 83616-4313 Ph: (208) 939-9195 | Eagle Chiropractic PC 5337 S State St Eagle ID 83616-4313 Ph: (208) 939-9195 |
| NPI Number | 1720188857 |
|---|---|
| Provider Enumeration Date | 09/25/2006 |
| Last Update Date | 10/11/2019 |
| Medicare PECOS PAC ID | 1153493416 |
|---|---|
| Medicare Enrollment ID | O20080701000293 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720188857 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | C561 (Idaho) | Primary |
| Provider Name | Shawn H Nord |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1346232501 PECOS PAC ID: 9830274265 Enrollment ID: I20080310000672 |
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