Healthcare Provider Details

I. General information

NPI: 1538365077
Provider Name (Legal Business Name): CALVIN P PRAMANN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 W COUNTRY CLUB BLVD
BIG BEAR CITY CA
92314-0297
US

IV. Provider business mailing address

PO BOX 297
BIG BEAR CITY CA
92314-0297
US

V. Phone/Fax

Practice location:
  • Phone: 909-585-2400
  • Fax: 909-585-7021
Mailing address:
  • Phone: 909-585-2400
  • Fax: 909-585-7021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC14725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: