Provider Demographics
NPI:1528324936
Name:CRANE CHIROPRACTIC CHTD
Entity type:Organization
Organization Name:CRANE CHIROPRACTIC CHTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-677-9020
Mailing Address - Street 1:2552 OVERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-2941
Mailing Address - Country:US
Mailing Address - Phone:208-677-9020
Mailing Address - Fax:208-677-1167
Practice Address - Street 1:2552 OVERLAND AVE
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-2941
Practice Address - Country:US
Practice Address - Phone:208-677-9020
Practice Address - Fax:208-677-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1672368Medicare PIN