Teton Headwaters, Inc Dba Aspen Wellness

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CHIA-462 Issued in ID

Legal business name

TETON HEADWATERS, INC DBA ASPEN WELLNESS

Practice address

164 North Main Street
Victor, ID 83455

Phone

(208) 787-1199

Fax

(208) 787-1199

NPI assigned

Apr 12, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. James K Davis, DCNPI 1902978323

Title

Owner

Phone

(208) 787-1199

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• James K Davis, DC

  • Chiropractor
  • Victor, ID
  • NPI 1902978323
  NPD (past) Authorized official
• Christina Ella Emde Riley, L.C.S.W.

  • Clinical Social Worker
  • Driggs, ID
  • NPI 1043377120
  NPD (past)

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710101381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 224",
            "address_2": "164 N MAIN STREET",
            "city": "VICTOR",
            "state": "ID",
            "postal_code": "834550224",
            "telephone_number": "208-787-1199",
            "fax_number": "208-787-1199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 NORTH MAIN STREET",
            "city": "VICTOR",
            "state": "ID",
            "postal_code": "83455",
            "telephone_number": "208-787-1199",
            "fax_number": "208-787-1199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TETON HEADWATERS, INC DBA ASPEN WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-787-1199",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "CHIA-462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Simmons, O.D.
• Sarah Smith, DPT
• McKenzie E. Steiner, NMD
• Tristan Taylor, D.D.S.
• Teton Dietetics LLC
• Teton Valley Health Care, Inc (Victor Clinic)
• Teton Valley Hosital & Surgicenter (Victor Medical Clinic)
• Teton Valley Vision PC
• Thomas L Simmons (Teton Valley Vision Clinic)
• Valley in Motion Physical Therapy, LLC

• Chiropractor in Victor, ID
• Providers in Victor, ID by specialty
• Chiropractor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.