Provider Demographics
NPI:1427062827
Name:RATHMANN, CYNTHIA LEE (DC)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LEE
Last Name:RATHMANN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:LEE
Other - Last Name:RATHMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 1178
Mailing Address - Street 2:
Mailing Address - City:CHALLIS
Mailing Address - State:ID
Mailing Address - Zip Code:83226
Mailing Address - Country:US
Mailing Address - Phone:208-879-2550
Mailing Address - Fax:208-879-3213
Practice Address - Street 1:1148 12TH ST
Practice Address - Street 2:
Practice Address - City:CHALLIS
Practice Address - State:ID
Practice Address - Zip Code:83226
Practice Address - Country:US
Practice Address - Phone:208-879-2550
Practice Address - Fax:208-879-3213
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U40594Medicare UPIN
1673928Medicare ID - Type UnspecifiedINDIVIDUAL #
1673919Medicare ID - Type UnspecifiedGROUP #