Provider Demographics
NPI: | 1063576619 |
---|---|
Name: | ARRINGTON, HOWARD RUSTY (DC) |
Entity type: | Individual |
Prefix: | DR |
First Name: | HOWARD |
Middle Name: | RUSTY |
Last Name: | ARRINGTON |
Suffix: | |
Gender: | M |
Credentials: | DC |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1122 EASTLAND DR N # 2 |
Mailing Address - Street 2: | |
Mailing Address - City: | TWIN FALLS |
Mailing Address - State: | ID |
Mailing Address - Zip Code: | 83301-8444 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 208-734-9531 |
Mailing Address - Fax: | 208-733-6969 |
Practice Address - Street 1: | 1122 EASTLAND DR N # 2 |
Practice Address - Street 2: | |
Practice Address - City: | TWIN FALLS |
Practice Address - State: | ID |
Practice Address - Zip Code: | 83301-8444 |
Practice Address - Country: | US |
Practice Address - Phone: | 208-734-9531 |
Practice Address - Fax: | 208-733-6969 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-12-20 |
Last Update Date: | 2016-01-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
ID | CHIA1053 | 111N00000X |
ID | NP-1688A | 363L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | |
No | 111N00000X | Chiropractic Providers | Chiropractor |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
ID | M8082987 | Medicaid | |
ID | U98769 | Medicare UPIN | |
ID | M8082987 | Medicaid |