Provider Demographics
NPI:1396982567
Name:OGATA CHIROPRACTIC INC
Entity type:Organization
Organization Name:OGATA CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:TY
Authorized Official - Middle Name:
Authorized Official - Last Name:OGATA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-938-3334
Mailing Address - Street 1:5418 N EAGLE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-0998
Mailing Address - Country:US
Mailing Address - Phone:208-938-3334
Mailing Address - Fax:208-938-3335
Practice Address - Street 1:5418 N EAGLE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-0998
Practice Address - Country:US
Practice Address - Phone:208-938-3334
Practice Address - Fax:208-938-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA920111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty