Individual
DR. JARED MARK SHELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC, BS, CSCS
Contact information
Practice address
45 W CENTER ST, SODA SPRINGS, ID 83276-1530
(208) 547-4518
(208) 547-4555
Mailing address
45 W CENTER ST, SODA SPRINGS, ID 83276-1530
(208) 547-4518
(208) 547-4555
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
CHIA-1284
ID
111NS0005X
Sports Physician Chiropractor
Primary
CHIA-1284
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1673568
MEDICARE INDIVIDUAL PTAN
ID
05
—
807952000
—
ID
Enumeration date
01/16/2008
Last updated
09/03/2008
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