OrganizationFull Life Chiropractic, Pa(<Unavail>)ChiropractorChiropractic ProvidersPractice Address2300 W Everest Ln, Suite #175, Meridian, ID 83646-5925(208) 895-0858PECOS EnrollmentBased on the most recent information from CMS, provider Full Life Chiropractic, Pa does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1740472844Provider TypeOrganizationFull NameFull Life Chiropractic, PaOther Name<Unavail>SubpartNoEnumeration Date8/13/2007Last Updated12/20/2010Contact InformationPractice LocationPractice Address2300 W Everest Ln, Suite #175, Meridian, ID 83646-5925Phone(208) 895-0858Fax(208) 895-0561Mailing LocationMailing Address2300 W Everest Ln, Suite #175, Meridian, ID 83646-5925Phone(208) 895-0858Fax(208) 895-0561Authorized OfficialNameMain, Jonathan Eric (Owner / President)Phone(208) 895-0858Provider TaxonomiesCodeDescriptionLicenseCode111N00000XPrimaryDescriptionChiropractorChiropractic ProvidersLicenseC9495IdahoProvider IdentifiersIDDescriptionIssuerIDC9722DescriptionOtherIssuerBCBSIdaho