| Organization Name: | JEROME CHIROPRACTIC CLINIC PLLC |
| NPI Number: | 1093009847 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK MCCLAIN SACCOMAN (PRESIDENT) |
| Mailing Address: | 213 S Lincoln Ave Jerome |
| State: | ID US |
| Postal Code: | 833382624 |
| Phone Number: | 2083240222 |
| Fax Number: | 2083240223 |
| NPI Enumeration Date: | 06/08/2011 |
| NPI Last Update Date: | 06/08/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | CHIA-650 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |