Provider Demographics
NPI:1346768843
Name:BRAMAN, SELENA RAE (DC, BSKIN)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:RAE
Last Name:BRAMAN
Suffix:
Gender:F
Credentials:DC, BSKIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 N MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2248
Mailing Address - Country:US
Mailing Address - Phone:280-884-5000
Mailing Address - Fax:
Practice Address - Street 1:1220 N MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2248
Practice Address - Country:US
Practice Address - Phone:208-884-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1691111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor