Pioneer Sports & Pain Center LLC

Primary specialty

Rehabilitation ChiropractorTaxonomy code 111NR0400X

License

CHIA-1159 Issued in ID

Legal business name

PIONEER SPORTS & PAIN CENTER LLC

Practice address

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

Phone

(208) 922-4908

Fax

(208) 922-4909

NPI assigned

Dec 17, 2010

Organization subpart

No

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

Authorized official

Name

Stephen Kyle BurtenshawNPI 1386652691

Title

Owner

Phone

(208) 922-4908

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in ID2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stephen Kyle Burtenshaw, D.C.

  • Chiropractor
  • Kuna, ID
  • NPI 1386652691

  ID

  Medicare reassignment Care Compare group Authorized official
• Cara Lynn Carpenter, DPT

  • Physical Therapist
  • Meridian, ID
  • NPI 1477718930

  ID

  Medicare reassignment Care Compare group NPD
• Dustin David Elliott

  • Chiropractor
  • Kuna, ID
  • NPI 1164968640

  ID

  Medicare reassignment Care Compare group NPD
• Danielle Renee Melton, DPT

  • Physical Therapist
  • Boise, ID
  • NPI 1255741963

  ID

  Medicare reassignment Care Compare group NPD
• Chelsea Beth Heffner, PA-C

  • Surgical Physician Assistant
  • Bellevue, WA
  • NPI 1740665009

  ID

  Medicare reassignment Care Compare group NPD
• Mary K Derlacki, FNP

  • Rheumatology Physician
  • Boise, ID
  • NPI 1609947431
  Care Compare group
• Ryan Casey

  • Physician Assistant
  • Meridian, ID
  • NPI 1144908252
  NPD
• Ashley Nicole Hall, FNP-C

  • Family Medicine Physician
  • Meridian, ID
  • NPI 1326722752
  NPD

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

{
    "created_epoch": "1292544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787529600000",
    "number": "1598068280",
    "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": [
        {
            "address_1": "9382 W Overland Rd",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837092505",
            "country_code": "US",
            "telephone_number": "208-922-4908",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PIONEER SPORTS & PAIN CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-17",
        "last_updated": "2026-08-24",
        "certification_date": "2026-08-24",
        "status": "A",
        "authorized_official_last_name": "BURTENSHAW",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "KYLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-922-4908"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "ID",
            "license": "CHIA-1159",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Marie Pearl, DDS
• Kimberlee A Peterson, PT
• Alexis Pettersen, PT, DPT
• Phalanx Wellness LLC
• Jana Adrienne Pintor, PHARM D
• Darrel Robert Porr, MD
• William Lincoln Poulson, NP-C
• Cameron Prien, OD
• Kara Dawn Prince, APRN, FNP-C
• Project Impact Stem Academy, Inc.

• All providers in Kuna, ID
• Rehabilitation Chiropractor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2026; 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.