Individual
DR. SAM MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
10316 USTICK RD STE 100, BOISE, ID 83704-5284
(208) 376-4364
Mailing address
10316 USTICK RD STE 100, BOISE, ID 83704-5284
(208) 376-4364
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-1050
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C4165
BLUE CROSS
ID
Enumeration date
12/20/2006
Last updated
07/08/2007
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