Provider Demographics
NPI:1124153432
Name:ANACKER, JENNIFER LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:ANACKER
Suffix:
Gender:F
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:PO BOX 2663
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83701
Mailing Address - Country:US
Mailing Address - Phone:208-287-2299
Mailing Address - Fax:208-287-2298
Practice Address - Street 1:300 MAIN STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702
Practice Address - Country:US
Practice Address - Phone:208-287-2299
Practice Address - Fax:208-287-2298
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIR997111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010157936OtherMERIDRAN OFFICE
C3548OtherBLUE CROSS OF IDAHO
ID000010139825OtherBLUE SHIELD BOISE OFFICE
ID1378832Medicare ID - Type UnspecifiedGROUP
C3548OtherBLUE CROSS OF IDAHO
ID000010157936OtherMERIDRAN OFFICE