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General NPI Number Information
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NPI Number | 1457537862
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Entity Type | Individual
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Provider Name | JARED MARK SHELTON DC, BS, CSCS
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Gender | Male
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 09/03/2008
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Provider Practice Location Address
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Address Line | 45 W CENTER ST
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City | SODA SPRINGS
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State | ID
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Zip | 83276-1530
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Country | US
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Telephone | 208-547-4518
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Fax | 208-547-4555
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Provider Business Mailing Address
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Address Line | 45 W CENTER ST
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City | SODA SPRINGS
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State | ID
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Zip | 83276-1530
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Country | US
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Telephone | 208-547-4518
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Fax | 208-547-4555
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIA-1284
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | CHIA-1284
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License Number State | ID
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