Provider Demographics
NPI:1528757507
Name:BONFIRE CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:BONFIRE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:WEED
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-266-7000
Mailing Address - Street 1:13965 W CHINDEN BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1457
Mailing Address - Country:US
Mailing Address - Phone:208-266-7000
Mailing Address - Fax:
Practice Address - Street 1:6291 N FOX RUN WAY STE 110
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6791
Practice Address - Country:US
Practice Address - Phone:208-266-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty