Active NPI
Jeffrey Thomas Welker, D.C.,C.C.S.P.
- Sports Physician Chiropractor
- Boise, ID
National Provider Identifier
1245389790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physician Chiropractor
- License
- C-520
- Practice address
- 301 N 27TH St
Boise, ID 83702-4725 - Phone
- (208) 343-2584
- NPI assigned
- Jan 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Physician Chiropractor | 111NS0005X | C-520 | ID | Primary |
Addresses
Primary practice location
301 N 27TH St
Boise, ID 83702-4725
Mailing address
301 N 27TH St
Boise, ID 83702-4725
Phone (208) 343-2584
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C-520-4 | Other | ID | BLUE CROSS OF IDAHO |
| 000010007866 | Other | ID | REGENCE BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120405000050 | ID | Practitioner - Chiropractic | 9032370721 | Practice locations: Boise, ID |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C-520 | ID | MD | Sports Physician Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1245389790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 N 27TH ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837024725",
"telephone_number": "208-343-2584"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 N 27TH ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837024725",
"telephone_number": "208-343-2584"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WELKER",
"first_name": "JEFFREY",
"middle_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "D.C.,C.C.S.P.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111NS0005X",
"taxonomy_group": "",
"desc": "Chiropractor, Sports Physician",
"state": "ID",
"license": "C-520",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF IDAHO",
"identifier": "C-520-4",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "000010007866",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.