Healthcare Provider Details

I. General information

NPI: 1497791677
Provider Name (Legal Business Name): BRADLEY J RANKIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 MAIN STREET
ASHTON ID
83420
US

IV. Provider business mailing address

PO BOX 400
ASHTON ID
83420-0400
US

V. Phone/Fax

Practice location:
  • Phone: 208-652-2225
  • Fax: 208-652-2226
Mailing address:
  • Phone: 208-652-2225
  • Fax: 208-652-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIA-1176
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: