Provider Demographics
NPI:1154514453
Name:BELNAP CHIROPRACTIC, P.A.
Entity type:Organization
Organization Name:BELNAP CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:BELNAP
Authorized Official - Suffix:
Authorized Official - Credentials:DC (CCEP
Authorized Official - Phone:208-233-3838
Mailing Address - Street 1:521 E HALLIDAY ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-6563
Mailing Address - Country:US
Mailing Address - Phone:208-233-3838
Mailing Address - Fax:208-478-1552
Practice Address - Street 1:521 E HALLIDAY ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-6563
Practice Address - Country:US
Practice Address - Phone:208-233-3838
Practice Address - Fax:208-478-1552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA827111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID350056584OtherRAIL ROAD MEDICARE
IDC5736OtherBLUE CROSS OF IDAHO
IDC9721OtherBLUE CROSS OF IDAHO
ID010025813OtherREGENCE
ID350056584OtherRAIL ROAD MEDICARE