Individual
DR. GARY D MUSGRAVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
3314 N. COLE RD., BOISE, ID 83704
(208) 377-9930
(208) 377-9932
Mailing address
3314 N. COLE RD., BOISE, ID 83704
(208) 377-9930
(208) 377-9932
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
1586
OH
111NS0005X
Sports Physician Chiropractor
Primary
CHIA-1306
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000136764
ANTHEM
OH
01
—
341690892-00
BWC
OH
Enumeration date
03/18/2007
Last updated
02/04/2009
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