Bear River Chiropractic, LLC
Organization Active NPI Chiropractor · Soda Springs, ID
NPI 1760617765 · NPPES record last updated Jun 9, 2009
Key facts
- NPI
- 1760617765
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- CHIA-1284 (ID)
- Legal business name
- BEAR RIVER CHIROPRACTIC, LLC
- Practice address
- 45 W Center St
Soda Springs, ID 83276-1530 - Phone
- (208) 547-4518
- Fax
- (208) 547-4555
- NPI assigned
- May 19, 2009
- Organization subpart
- No
Authorized official
- Name
- Dr. Jared Shelton, DC
- Title
- Manager
- Phone
- (208) 547-4518
Practitioners 1
-
Jared Mark Shelton, DC, BS, CSCS
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 13D2058933 | Bear River Chiropractic | Certificate of waiver | May 14, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090609000362 | ID | Part B Supplier - Clinic/Group Practice | 6204986458 |
Receives reassigned benefits from 1 practitioner Practice locations: Soda Springs, ID |
National Provider Directory
Locations
45 W Center St
Soda Springs, ID 83276
Phone (208) 547-4518
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | CHIA-1284 | ID | Yes |
Addresses
Primary practice location
45 W Center St
Soda Springs, ID 83276-1530
Mailing address
45 W Center St
Soda Springs, ID 83276-1530
Phone (208) 547-4518
Other providers in Soda Springs, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 9, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.