David George Booth, D.C. – Chiropractor

Key facts

NPI: 1992838601
Entity type: Individual (NPI type 1)
Primary specialty: Chiropractor 111N00000X
License: CHIA804 (ID)
Practice address: 60 S 2ND W
Rexburg, ID 83440-1819
Phone: (208) 359-2264
Fax: (208) 359-0650
NPI assigned: Mar 13, 2007
Sex: Male
Sole proprietor: No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Aspen Managment Services Inc Chiropractor · Idaho Falls, ID · NPI 1841370053

Medicare reassignment Care Compare group NPD CHIROPRACTOR · ID
Back to Health Chiropractic LLC Medical Specialty Clinic/Center · Rexburg, ID · NPI 1740812320

NPD

Medicare Care Compare profile

Specialty: Chiropractic
Education: Western States College of Chiropractic, 1995
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Aspen Managment Services Inc (3 clinicians)

Practice addresses (Care Compare)

645 S Woodruff Ave
Idaho Falls, ID 83401-5596
Phone (208) 552-9886

Medicare participation

Medicare fee-for-service enrollment: Enrolled in ID

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20070724000833	ID	Practitioner - Chiropractic	3072614734	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
CHIA804	ID	MD	Chiropractor

Practice roles

Organization	Specialty	Status	New patients
Aspen Managment Services Inc	Chiropractor	Current since Jan 21, 2020	Accepting new patients
Back to Health Chiropractic LLC		Current since Feb 16, 2020	Accepting new patients

Locations

645 S Woodruff Ave
Idaho Falls, ID 83401
Phone (208) 552-9886

60 S 2nd W
Rexburg, ID 83440
Phone (208) 357-2264

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Chiropractor	111N00000X	CHIA804	ID	Yes

Addresses

Primary practice location

60 S 2ND W
Rexburg, ID 83440-1819

Mailing address

645 S Woodruff Ave
Idaho Falls, ID 83401-5596
Phone (208) 552-9886

Other identifiers

Identifier	Type	State	Issuer
C8042	Other	ID	BLUE CROSS NUMBER
805108000	Medicaid	ID

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 21, 2020.

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579564800000",
    "number": "1992838601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015596",
            "telephone_number": "208-552-9886",
            "fax_number": "208-552-9843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 S 2ND W",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401819",
            "telephone_number": "208-359-2264",
            "fax_number": "208-359-0650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOTH",
        "first_name": "DAVID",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-13",
        "last_updated": "2020-01-21",
        "certification_date": "2020-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "CHIA804",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS NUMBER",
            "identifier": "C8042",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805108000",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rexburg, ID

All providers in Rexburg, ID · Chiropractor in Idaho

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2020. 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.

Verify at the official NPI Registry.