NPIMap

Organization Active NPI

Grand Teton Chiropractic, PLLC

  • Chiropractor
  • Idaho Falls, ID
National Provider Identifier
1891880779
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIA 904 Issued in ID
Legal business name
GRAND TETON CHIROPRACTIC, PLLC
Practice address
1387 Cambridge Dr
Suite 100
Idaho Falls, ID 83401-4257
Phone
(208) 529-1919
Fax
(208) 552-9447
NPI assigned
Oct 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. James Criddle Gardner, D.C.NPI 1821036856
Title
Owner/Manager
Phone
(208) 529-1919

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
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X CHIA 904 ID Primary

Addresses

Primary practice location

1387 Cambridge Dr
Suite 100
Idaho Falls, ID 83401-4257

Mailing address

4317 Amber LN
Ammon, ID 83406-4640
Phone (208) 529-1919

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891880779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4317 AMBER LN",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834064640",
            "telephone_number": "208-529-1919",
            "fax_number": "208-552-9447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1387 CAMBRIDGE DR",
            "address_2": "SUITE 100",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014257",
            "telephone_number": "208-529-1919",
            "fax_number": "208-552-9447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND TETON CHIROPRACTIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "CRIDDLE",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "208-529-1919",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "CHIA 904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

  • 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.