Organization
BOISE SPORTS CHIROPRACTIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN HEARON D.C., C.C.S.P (OWNER)
(208) 377-9930
Entity
Organization
Contact information
Practice address
3314 N COLE RD, BOISE, ID 83704-4403
(208) 377-9930
Mailing address
3314 N COLE RD, BOISE, ID 83704-4403
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
C-4918
ID
111NN1001X
Nutrition Chiropractor
C-4918
ID
111NR0400X
Rehabilitation Chiropractor
C-4918
ID
111NS0005X
Sports Physician Chiropractor
C-4918
ID
111NX0800X
Orthopedic Chiropractor
Primary
C-4918
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C-4918
IDAHO LICENSE NO.
ID
Enumeration date
07/02/2007
Last updated
09/11/2025
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