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Bonfire Chiropractic Pllc

Chiropractor

Chiropractic Providers

6291 N Fox Run Way Ste 110, Meridian, ID 83646-6791

PECOS Enrollment

Based on the most recent information from CMS, provider Bonfire Chiropractic Pllc does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1528757507
Provider Type
Organization
Full Name
Bonfire Chiropractic Pllc

Subpart
No
Enumeration Date
5/4/2023
Last Updated
5/4/2023

Contact Information

Practice Location

6291 N Fox Run Way Ste 110, Meridian, ID 83646-6791

(208) 266-7000

Unlisted Fax

Mailing Location

13965 W Chinden Blvd Ste 110, Boise, ID 83713-1457

(208) 266-7000

Unlisted Fax

Authorized Official

Weed, Ryan B (Member)

(208) 266-7000

Provider Taxonomies

Code	Description	License
Code 111N00000X Primary	Description Chiropractor Chiropractic Providers	License Unlisted Issuer

Bonfire Chiropractic Pllc

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

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Stadlbauer, Shawn

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Lee, Jason Charles

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Gallegos-Main, Rosalinda