Healthcare Provider Details

I. General information

NPI: 1235354135
Provider Name (Legal Business Name): MITCHELL LEE JEPHSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 1/2 E MAIN ST
RIGBY ID
83442-1417
US

IV. Provider business mailing address

P.O. BOX 181
RIGBY ID
83442-0181
US

V. Phone/Fax

Practice location:
  • Phone: 208-745-1212
  • Fax:
Mailing address:
  • Phone: 208-745-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA-935
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: