Provider Demographics
NPI:1437116910
Name:RAYMER, ANN L (DC)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:L
Last Name:RAYMER
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:PO BOX 9124
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-1624
Mailing Address - Country:US
Mailing Address - Phone:208-882-3723
Mailing Address - Fax:208-883-1849
Practice Address - Street 1:1246 W A ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2277
Practice Address - Country:US
Practice Address - Phone:208-882-3723
Practice Address - Fax:208-883-1849
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA0471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1671717Medicare ID - Type Unspecified