Active NPI
Gwendolyn Ann Vandooren, D.C.
- Chiropractor
- Hailey, ID
National Provider Identifier
1316084643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CHIA866
- Practice address
- 17 Buttercup Rd
Hailey, ID 83333-5097 - Phone
- (208) 788-1863
- NPI assigned
- Jan 30, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CHIA866 | ID | Primary |
| Chiropractor | 111N00000X | CH00002501 | WA | |
| Chiropractor | 111N00000X | 282720 | OR |
Addresses
Primary practice location
17 Buttercup Rd
Hailey, ID 83333-5097
Mailing address
17 Buttercup Rd
Hailey, ID 83333-5097
Phone (208) 788-1863
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C8661 | Other | ID | BLUE CROSS OF IDAHO |
| 000010028728 | Other | ID | REGENCE BLUE SHIELD OF ID |
Other names 1
- Dr. Gwendolyn Ann Thompson Vandooren
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CHIA866 | ID | MD | Chiropractor |
| 282720 | OR | MD | Chiropractor |
| CH00002501 | WA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1316084643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 BUTTERCUP RD",
"city": "HAILEY",
"state": "ID",
"postal_code": "833335097",
"telephone_number": "208-788-1863"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 BUTTERCUP RD",
"city": "HAILEY",
"state": "ID",
"postal_code": "833335097",
"telephone_number": "208-788-1863"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDOOREN",
"first_name": "GWENDOLYN",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "ID",
"license": "CHIA866",
"primary": true
},
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WA",
"license": "CH00002501",
"primary": false
},
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "OR",
"license": "282720",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF IDAHO",
"identifier": "C8661",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD OF ID",
"identifier": "000010028728",
"state": "ID"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "GWENDOLYN",
"last_name": "THOMPSON VANDOOREN",
"middle_name": "ANN",
"prefix": "DR.",
"credential": "D.C.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Hailey, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.