Provider Demographics
NPI:1144878091
Name:AARON STERN CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:AARON STERN CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:INMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-726-4555
Mailing Address - Street 1:PO BOX 6003
Mailing Address - Street 2:
Mailing Address - City:KETCHUM
Mailing Address - State:ID
Mailing Address - Zip Code:83340-6003
Mailing Address - Country:US
Mailing Address - Phone:208-726-4555
Mailing Address - Fax:
Practice Address - Street 1:128 SADDLE ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340-8334
Practice Address - Country:US
Practice Address - Phone:208-726-4555
Practice Address - Fax:208-928-4851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1124335906Medicaid