Provider Demographics
NPI:1760566699
Name:WELKER, JASON BLAIN (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:BLAIN
Last Name:WELKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 S 800 W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PRESTON
Mailing Address - State:ID
Mailing Address - Zip Code:83263-5444
Mailing Address - Country:US
Mailing Address - Phone:208-852-2875
Mailing Address - Fax:253-563-5264
Practice Address - Street 1:1514 S 800 W
Practice Address - Street 2:SUITE 100
Practice Address - City:PRESTON
Practice Address - State:ID
Practice Address - Zip Code:83263-5444
Practice Address - Country:US
Practice Address - Phone:208-852-2875
Practice Address - Fax:253-563-5264
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4842701-1202111N00000X
IDCHIA-1225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT48517OtherALTIUS
UT870395551JW1OtherEDUCATORS MUTUAL
UT63907OtherPEHP
ID000010159993OtherBLUE SHIELD OF IDAHO
IDCS661OtherBLUE CROSS IDAHO