Provider Demographics
NPI:1942353347
Name:CRAMER, JERRY BRENT (DC)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:BRENT
Last Name:CRAMER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8305 NORTHVIEW ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7133
Mailing Address - Country:US
Mailing Address - Phone:208-377-2266
Mailing Address - Fax:208-377-2268
Practice Address - Street 1:8305 NORTHVIEW ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-7133
Practice Address - Country:US
Practice Address - Phone:208-377-2266
Practice Address - Fax:208-377-2268
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000010008192OtherBLUE SHIELD
IDC3811OtherBLUECROSS
ID1671331Medicare PIN