Provider Demographics
NPI:1124153515
Name:BRAMWELL, DAVID L (DC, DABCO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:BRAMWELL
Suffix:
Gender:M
Credentials:DC, DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 SHOUP AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-3603
Mailing Address - Country:US
Mailing Address - Phone:208-529-2057
Mailing Address - Fax:208-529-6857
Practice Address - Street 1:402 SHOUP AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3603
Practice Address - Country:US
Practice Address - Phone:208-529-2057
Practice Address - Fax:208-529-6857
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDC-465111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010008956OtherREGENCE BLUE SHIELD
IDCHIA-465OtherLICENSE
IDC9172OtherBLUE CROSS
IDCHIA-465OtherLICENSE
IDC9172OtherBLUE CROSS