Individual
DR. BRIAN J RAE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1149 W BOISE AVE, BOISE, ID 83706-3503
(208) 345-3630
(208) 345-3640
Mailing address
1149 W BOISE AVE, BOISE, ID 83706-3503
(208) 345-3630
(208) 345-3640
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA1046
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010145456
REGENCE BLUE SHIELD
ID
01
—
C5695
BLUE CROSS
ID
Enumeration date
01/30/2007
Last updated
02/28/2008
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