Individual ProviderJonathan Eric MainChiropractorChiropractic ProvidersPractice Address2300 W Everest Ln, Suite #175, Meridian, ID 83646-5925(208) 895-0858PECOS EnrollmentBased on the most recent information from CMS, provider Jonathan Eric Main 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 ID1790810380Provider TypeIndividualFull NameMain, Jonathan EricTitleDr.CredentialDCGenderMaleSole ProprietorNoEnumeration Date2/22/2007Last 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) 895-0561Provider TaxonomiesCodeDescriptionLicenseCode111N00000XPrimaryDescriptionChiropractorChiropractic ProvidersLicenseCHIA-991IdahoProvider IdentifiersIDDescriptionIssuerIDC3167DescriptionOtherIssuerBLUE CROSS BLUE SHIELDIdaho