Provider Demographics
NPI:1104968411
Name:CRANE, STEPHEN RODNEY (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:RODNEY
Last Name:CRANE
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 1:9762 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:STAR
Mailing Address - State:ID
Mailing Address - Zip Code:83669-5766
Mailing Address - Country:US
Mailing Address - Phone:208-286-7733
Mailing Address - Fax:208-392-1940
Practice Address - Street 1:9762 W STATE ST
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:ID
Practice Address - Zip Code:83669-5766
Practice Address - Country:US
Practice Address - Phone:208-286-7733
Practice Address - Fax:208-392-1940
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2016-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA 1084111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010147777OtherBLUE SHIELD
IDC4173OtherBLUE CROSS
ID1675704Medicare ID - Type Unspecified
IDC4173OtherBLUE CROSS