Provider Demographics
NPI:1093979023
Name:KRAMER, JEANETTE SUSAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:SUSAN
Last Name:KRAMER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-2679
Mailing Address - Country:US
Mailing Address - Phone:928-778-1554
Mailing Address - Fax:270-778-1554
Practice Address - Street 1:412 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2679
Practice Address - Country:US
Practice Address - Phone:928-778-1554
Practice Address - Fax:270-778-1554
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor