Individual provider Active NPI

Benjamin Dylan Weiss, DC

  • Chiropractor
  • Garden City, ID
National Provider Identifier
1912473224
Registry record updated Oct 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIA1945 Issued in ID
Practice address
5663 N Glenwood St Ste 102
Garden City, ID 83714-1339
Phone
(208) 860-2621
Fax
(208) 561-8877
NPI assigned
Oct 15, 2018
Last updated
Oct 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 0104557516 VA
Chiropractor 111N00000X CHIA1945 ID Primary

Addresses

Primary practice location

5663 N Glenwood St Ste 102
Garden City, ID 83714-1339

Mailing address

5663 N Glenwood St Ste 102
Garden City, ID 83714-1339

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200122002637 ID Practitioner - Chiropractic 5193079986 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 2018
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

6744 N Glenwood St
Boise, ID 83714-1926
Phone (208) 748-5909

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CHIA1945IDMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Trueform Health Solutions Chiropractor CurrentSince May 13, 2024 Accepting new patients
Optimal Spine & Posture CurrentSince Dec 1, 2023 Accepting new patients
Przybysz Chiropractic PLLC Chiropractor PastSince Oct 19, 2018 Accepting new patients

Locations

6744 N Glenwood St
Boise, ID 83714
Phone (208) 748-5909

5663 N Glenwood St
Ste 102
Garden City, ID 83714
Phone (208) 860-2621

Organizations & group practices 3

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": "1539561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791849600000",
    "number": "1912473224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5663 N GLENWOOD ST STE 102",
            "city": "GARDEN CITY",
            "state": "ID",
            "postal_code": "837141339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5663 N GLENWOOD ST STE 102",
            "city": "GARDEN CITY",
            "state": "ID",
            "postal_code": "837141339",
            "telephone_number": "208-860-2621",
            "fax_number": "208-561-8877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEISS",
        "first_name": "BENJAMIN",
        "middle_name": "DYLAN",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-15",
        "last_updated": "2026-10-13",
        "certification_date": "2026-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104557516",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "CHIA1945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden City, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2026; 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.