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General NPI Number Information
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NPI Number | 1982009122
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Entity Type | Organization
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Legal Business Name | MUSHIN, INC.
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 12/24/2014
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Provider Practice Location Address
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Address Line | 1580 E STATE ST SUITE 104
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City | EAGLE
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State | ID
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Zip | 83616-6853
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Country | US
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Telephone | 208-939-3737
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Fax | 208-939-2538
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Provider Business Mailing Address
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Address Line | 1580 E STATE ST SUITE 104
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City | EAGLE
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State | ID
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Zip | 83616-6853
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Country | US
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Telephone | 208-939-3737
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Fax | 208-939-2538
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TODD CRAMER
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Credential | D.C.
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Telephone | 208-939-3737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIA-773
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License Number State | ID
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