Healthcare Provider Details

I. General information

NPI: 1841142304
Provider Name (Legal Business Name): JARED MITCHELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 12TH AVE RD
NAMPA ID
83686-8400
US

IV. Provider business mailing address

4019 N BOLD STRIPE AVE
MERIDIAN ID
83646-4060
US

V. Phone/Fax

Practice location:
  • Phone: 208-599-1448
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7671498
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: