Provider Demographics
NPI:1083105639
Name:CRAM CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:CRAM CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:CRAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-659-8155
Mailing Address - Street 1:602 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:IA
Mailing Address - Zip Code:52742
Mailing Address - Country:US
Mailing Address - Phone:563-659-8155
Mailing Address - Fax:563-659-3520
Practice Address - Street 1:602 12TH STREET
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:IA
Practice Address - Zip Code:52742
Practice Address - Country:US
Practice Address - Phone:563-659-8155
Practice Address - Fax:563-659-3520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA075791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty