Organization
BACK COUNTRY CHIROPRACTIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL CLEMENT HILL DC (OWNER/ CHIROPRACTIC PHYSICIAN)
(208) 624-2222
Entity
Organization
Contact information
Practice address
104 N BRIDGE ST, SUITE 104, SAINT ANTHONY, ID 83445-1455
(208) 624-2222
(208) 624-2220
Mailing address
PO BOX 586, SAINT ANTHONY, ID 83445-0586
(208) 624-2222
(208) 624-2220
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-1145
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010154569
REGENCE BS
ID
01
—
1369096
GROUP PRICING NUMBER
ID
01
—
1670479
PERFORMING PROVIDER NUMBE
ID
01
—
C9670
BC OF IDAHO
ID
Enumeration date
07/26/2007
Last updated
07/26/2007
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