Provider Demographics
NPI:1861994659
Name:COMPLETE HEALTH CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:COMPLETE HEALTH CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-312-0559
Mailing Address - Street 1:212 5TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-3740
Mailing Address - Country:US
Mailing Address - Phone:208-312-0559
Mailing Address - Fax:208-907-0975
Practice Address - Street 1:212 5TH AVE S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3740
Practice Address - Country:US
Practice Address - Phone:208-312-0559
Practice Address - Fax:208-907-0975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty