Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | C-465 | ID |
NPI | 1124153515 |
---|---|
Provider Name | Dr. David L Bramwell |
First Address | Idaho Falls, ID 83402-3603 |
Second Address | Idaho Falls, ID 83402-3603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 13/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000010008956 | REGENCE BLUE SHIELD (01) | ID |
1671854 | (02) | ID |
C9172 | BLUE CROSS (01) | ID |
CHIA-465 | LICENSE (01) | ID |