Provider Demographics
NPI:1679642888
Name:EAGLE CRAMER CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:EAGLE CRAMER CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:R
Authorized Official - Last Name:CRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-939-3737
Mailing Address - Street 1:1580 E STATE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6853
Mailing Address - Country:US
Mailing Address - Phone:208-939-3737
Mailing Address - Fax:208-939-2538
Practice Address - Street 1:1580 E STATE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6853
Practice Address - Country:US
Practice Address - Phone:208-939-3737
Practice Address - Fax:208-939-2538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA773111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1675182Medicare ID - Type UnspecifiedMEDICARE