Individual
MINDY MCCROCKLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
2128 N COLE RD, BOISE, ID 83704-7311
(208) 249-9629
Mailing address
2128 N COLE RD, BOISE, ID 83704-7311
(208) 249-9629
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-1621
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
IDMCD
—
ID
Enumeration date
07/20/2016
Last updated
07/20/2016
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