Provider Demographics
NPI:1528127453
Name:CRAMER COULTER, THERESA M (DC)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:M
Last Name:CRAMER COULTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4619 EMERALD ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-2051
Mailing Address - Country:US
Mailing Address - Phone:208-367-1497
Mailing Address - Fax:
Practice Address - Street 1:4619 EMERALD ST STE 102
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-2051
Practice Address - Country:US
Practice Address - Phone:208-367-1497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010020165OtherREGENCE BLUE SHIELD OF ID
IDC3449OtherIDAHO BLUE CROSS
IDC3449OtherIDAHO BLUE CROSS