National Provider Identifier Database

IDAHO SPORTS MEDICINE INSTITUTE PA
Neuromusculoskeletal Medicine, Sports Medicine

A Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine physician trained to be responsible for the continuous care in the field of sports medicine encompasses increased knowledge and understanding of osteopathic principles and practice and heightened technical skills of osteopathic manipulative medicine and integrates each of these into the management of the individual engaged in physical exercise (sports) whether as an individual or in team participation.


Contact Information

IDAHO SPORTS MEDICINE INSTITUTE PA
1188 UNIVERSITY DR
BOISE, ID83706-3009
Phone: 208-336-8250
Fax: 208-345-9514
Website:
Specialty Taxonomy Code
* Neuromusculoskeletal Medicine, Sports Medicine 204C00000X

* Indicates primary specialty

NPI Profile & details for IDAHO SPORTS MEDICINE INSTITUTE PA

NPI Number 1154356624
Legal business name
LBN
IDAHO SPORTS MEDICINE INSTITUTE PA
Authorized official JENNIFER MILLIER - (OWNER/PARTNER)
Entity Organization
Organization subpart No
Enumeration date 07/12/2006
Last updated 01/06/2026 - About 5 months ago
Sole proprietor1 Not specified
Identifiers
  • License #: N/A FOR GROUP
  • ID Medicaid: 805993900
  • ID Other: 8628-0 BLUE CROSS OF IDAHO GROUP
  • ID Other: REGENCE BLUE SHIELD GROUP # 29145

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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