Healthcare Provider Details

I. General information

NPI: 1083133383
Provider Name (Legal Business Name): LEVI CADMAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 S MAPLE GROVE RD STE 200
BOISE ID
83709-1610
US

IV. Provider business mailing address

1390 S MAPLE GROVE RD STE 200
BOISE ID
83709-1610
US

V. Phone/Fax

Practice location:
  • Phone: 208-672-0100
  • Fax:
Mailing address:
  • Phone: 208-672-0100
  • Fax: 208-672-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number60784235
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5171646
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: