Jared Mark Shelton, DC, BS, CSCS

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

CHIA-1284 Issued in ID

Practice address

45 W Center St
Soda Springs, ID 83276-1530

Phone

(208) 547-4518

Fax

(208) 547-4555

NPI assigned

Jan 16, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Specialty

Chiropractic

Education

Western States College of Chiropractic, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Science

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.

• Bear River Chiropractic, LLC

  • Chiropractor
  • Soda Springs, ID
  • NPI 1760617765
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1200441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220400000000",
    "number": "1457537862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 W CENTER ST",
            "city": "SODA SPRINGS",
            "state": "ID",
            "postal_code": "832761530",
            "telephone_number": "208-547-4518",
            "fax_number": "208-547-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 W CENTER ST",
            "city": "SODA SPRINGS",
            "state": "ID",
            "postal_code": "832761530",
            "telephone_number": "208-547-4518",
            "fax_number": "208-547-4555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELTON",
        "first_name": "JARED",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "DC, BS, CSCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-16",
        "last_updated": "2008-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "CHIA-1284",
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "ID",
            "license": "CHIA-1284",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807952000",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL PTAN",
            "identifier": "1673568",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Craig Harden Richardson, LAT, ATC
• RMC Management, LLC
• Ronald Rutten
• Terry H. Sanderson, O.D.
• Saxton Medical Supply LLC
• Brett A Smith, PA-C
• Kevin Courtney Smith, DPT
• Soda Smiles, Inc
• Soda Springs School District
• David C Telford

• Sports Physician Chiropractor in Soda Springs, ID
• Providers in Soda Springs, ID by specialty
• Sports Physician Chiropractor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2008; 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.