Dustin David Elliott

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CHIA-1734 Issued in ID

Practice address

757 E Wythe Creek CT Ste 102
Kuna, ID 83634-5006

Phone

(208) 922-4908

Fax

(208) 922-4909

NPI assigned

Jan 9, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Specialty

Chiropractic

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pioneer Sports and Pain Center LLCGroup PAC ID 8325263379, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pioneer Sports & Pain Center LLC

  • Rehabilitation Chiropractor
  • Kuna, ID
  • NPI 1598068280

  ID

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1483920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483920000000",
    "number": "1164968640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "757 E WYTHE CREEK CT STE 102",
            "city": "KUNA",
            "state": "ID",
            "postal_code": "836345006",
            "telephone_number": "208-922-4908",
            "fax_number": "208-922-4909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "757 E WYTHE CREEK CT STE 102",
            "city": "KUNA",
            "state": "ID",
            "postal_code": "836345006",
            "telephone_number": "208-922-4908",
            "fax_number": "208-922-4909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "DUSTIN",
        "middle_name": "DAVID",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-09",
        "last_updated": "2017-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "CHIA-1734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dominique Domingo, LPC
• Allison Dreher, RN
• Sabrina Denise Dunn
• Brandilyn Durrant
• Amanda Irene Dymen
• Kevin Michael Elliott, DMD
• Rocky Wade Elsasser, DPT
• Ryan R. Emry, M.ED., M.A., LPC
• Jeffrey Epperson
• Julio Orlando Escobar, D.D.S.

• All providers in Kuna, ID
• Chiropractor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.