Provider Demographics
NPI:1548514409
Name:HIGHLAND CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:HIGHLAND CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:OGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-939-0775
Mailing Address - Street 1:13999 W WAINWRIGHT DR STE 201
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1967
Mailing Address - Country:US
Mailing Address - Phone:208-939-0775
Mailing Address - Fax:208-301-5004
Practice Address - Street 1:13999 W WAINWRIGHT DR STE 201
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-1967
Practice Address - Country:US
Practice Address - Phone:208-939-0775
Practice Address - Fax:208-301-5004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1518111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty