Provider Demographics
NPI:1295921278
Name:DR. JASON B. WELKER, D.C. P.C.
Entity type:Organization
Organization Name:DR. JASON B. WELKER, D.C. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:BLAIN
Authorized Official - Last Name:WELKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-852-2875
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010159993OtherBLUE SHIELD OF IDAHO
UT48517OtherALTIUS
UT870395551JW1OtherEDUCATORS MUTUAL
IDC5661OtherBLUE CROSS IDAHO
UT63907OtherPEHP