Craniospinal Institute PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

CRANIOSPINAL INSTITUTE PLLC

Practice address

2860 Channing Way
Ste 114
Idaho Falls, ID 83404-7531

Phone

(208) 535-4343

Fax

(208) 535-4344

NPI assigned

Nov 13, 2007

Last updated

Jan 4, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Shane Mangrum, M.D.

Title

Owner

Phone

(208) 535-4343

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199404800000",
    "number": "1851571376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2860 CHANNING WAY",
            "address_2": "STE 114",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047531",
            "telephone_number": "208-535-4343",
            "fax_number": "208-535-4344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2860 CHANNING WAY",
            "address_2": "STE 114",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047531",
            "telephone_number": "208-535-4343",
            "fax_number": "208-535-4344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRANIOSPINAL INSTITUTE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-13",
        "last_updated": "2008-01-04",
        "status": "A",
        "authorized_official_last_name": "MANGRUM",
        "authorized_official_first_name": "SHANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-535-4343",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Specialist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.