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BOISE PAIN MANAGEMENT

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Company Details

Name: BOISE PAIN MANAGEMENT
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 24 Oct 2013 (12 years ago)
Entity Number: 505169
Place of Formation: IDAHO
File Number: 0000505169
ZIP code: 83646
County: Ada County
Mailing Address: 451 SEDGEWICK DR MERIDIAN, ID 83646

National Provider Identifier

NPI Number:
1871856047

Authorized Person:

Name:
MR. MICHAEL JOSEPH PLYER
Role:
NCTMB
Phone:

Taxonomy:

Selected Taxonomy:
225700000X - Massage Therapist
Is Primary:
Yes

Contacts:

Fax:
2083764621

Filing

Filing Name Filing Number Filing date
Initial Filing 0000505169 2013-10-24

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Date of last update: 26 Sep 2024

Sources: Idaho Secretary of State