Organization Active NPI

Art of Motion Chiropractic and Sports Medicine PLLC

  • Chiropractor
  • Pocatello, ID
National Provider Identifier
1780096990
Registry record updated Oct 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIA-1603 Issued in ID
Legal business name
ART OF MOTION CHIROPRACTIC AND SPORTS MEDICINE PLLC
Practice address
1800 Flandro Dr
Suite 130
Pocatello, ID 83202-4912
Phone
(208) 242-3723
Fax
(208) 904-1052
NPI assigned
May 22, 2014
Last updated
Oct 13, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2014

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

Authorized official

Name
Shaloam Agalelei Ofisa, D.C., M.S.NPI 1952713166
Title
Owner
Phone
(208) 242-3723

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CHIA-1603 ID Primary

Addresses

Primary practice location

1800 Flandro Dr
Suite 130
Pocatello, ID 83202-4912

Mailing address

1800 Flandro Dr
Suite 130
Pocatello, ID 83202-4912
Phone (208) 242-3723

Other identifiers 1

IdentifierTypeStateIssuer
1952713166MedicaidID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141014000394 ID Part B Supplier - Clinic/Group Practice 8527288612 Receives reassigned benefits from 3 practitioners
Practice locations: Pocatello, ID

National Provider Directory

National Provider Directory

Locations

1800 Flandro Dr
Ste 130
Pocatello, ID 83202
Phone (208) 221-2973

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1400716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413158400000",
    "number": "1780096990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 FLANDRO DR",
            "address_2": "SUITE 130",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832024912",
            "telephone_number": "208-242-3723",
            "fax_number": "208-904-1052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 FLANDRO DR",
            "address_2": "SUITE 130",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832024912",
            "telephone_number": "208-242-3723",
            "fax_number": "208-904-1052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ART OF MOTION CHIROPRACTIC AND SPORTS MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-22",
        "last_updated": "2014-10-13",
        "status": "A",
        "authorized_official_last_name": "OFISA",
        "authorized_official_first_name": "SHALOAM",
        "authorized_official_middle_name": "AGALELEI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-242-3723",
        "authorized_official_credential": "D.C., M.S."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "CHIA-1603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1952713166",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.