Provider Demographics
NPI:1306264452
Name:INGHILTERRA, JEROME F (DC)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:F
Last Name:INGHILTERRA
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 1:1256 E KATIE CT
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-9295
Mailing Address - Country:US
Mailing Address - Phone:208-277-7184
Mailing Address - Fax:
Practice Address - Street 1:1256 E KATIE CT
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-9295
Practice Address - Country:US
Practice Address - Phone:208-277-7184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor