Provider Demographics
NPI:1972521326
Name:PARKER, JASON WYLIE (DC, NMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:WYLIE
Last Name:PARKER
Suffix:
Gender:M
Credentials:DC, NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 S SOMMER DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83406-8399
Mailing Address - Country:US
Mailing Address - Phone:208-339-1975
Mailing Address - Fax:
Practice Address - Street 1:7105 S SOMMER DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83406-8399
Practice Address - Country:US
Practice Address - Phone:208-339-1975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-972111N00000X
ID6761369175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID6761369OtherIDAHO BOARD OF NATUROPATHIC HEALTH CARE
ID1674865Medicare ID - Type Unspecified