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Organization
CRANIOSPINAL INSTITUTE PLLC
Active
Organization
CRANIOSPINAL INSTITUTE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANE MANGRUM M.D. (OWNER)
(208) 535-4343
Entity
Organization
Contact information
Practice address
2860 CHANNING WAY, STE 114, IDAHO FALLS, ID 83404-7531
(208) 535-4343
(208) 535-4344
Mailing address
2860 CHANNING WAY, STE 114, IDAHO FALLS, ID 83404-7531
(208) 535-4343
(208) 535-4344
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
NULL
174400000X
Specialist
Primary
—
—
Other
Enumeration date
11/13/2007
Last updated
01/04/2008
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