Individual provider Active NPI

Dillon Jade Michael, DC

  • Chiropractor
  • Eagle, ID
National Provider Identifier
1619737335
Registry record updated Apr 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2171641 Issued in ID
Practice address
1299 E Iron Eagle Dr Ste 130
Eagle, ID 83616-6869
Phone
(208) 582-3421
NPI assigned
Mar 20, 2024
Last updated
Apr 9, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2171641 ID Primary

Addresses

Primary practice location

1299 E Iron Eagle Dr Ste 130
Eagle, ID 83616-6869

Mailing address

1500 S Lamar Blvd Apt 3057
Austin, TX 78704-2949

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250611003138 ID Practitioner - Chiropractic 4385154913 Practice locations: Eagle, ID

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1299 E Iron Eagle Dr
Suite 130
Eagle, ID 83616-6599
Phone (208) 922-6612

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2171641IDMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Michael Wellness Ventures PLLC Chiropractor CurrentSince Apr 20, 2025 Accepting new patients
Cedar Park Chiropractic Clinic, Inc. Chiropractor PastSince Mar 1, 2024 Accepting new patients

Locations

1299 E Iron Eagle Dr
Ste 130
Eagle, ID 83616
Phone (208) 922-6612

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1710892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744156800000",
    "number": "1619737335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 S LAMAR BLVD APT 3057",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787042949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1299 E IRON EAGLE DR STE 130",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166869",
            "telephone_number": "208-582-3421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICHAEL",
        "first_name": "DILLON",
        "middle_name": "JADE",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-03-20",
        "last_updated": "2025-04-09",
        "certification_date": "2025-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "2171641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2025; 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.