Individual
DR. JONATHAN ERIC MAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
2300 W EVEREST LN, SUITE #175, MERIDIAN, ID 83646-5925
(208) 895-0858
(208) 895-0561
Mailing address
2300 W EVEREST LN, SUITE #175, MERIDIAN, ID 83646-5925
(208) 895-0858
(208) 895-0561
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-991
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C3167
BLUE CROSS BLUE SHIELD
ID
Enumeration date
02/22/2007
Last updated
12/20/2010
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