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CRANIOSPINAL INSTITUTE PLLC

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Company Details

Name: CRANIOSPINAL INSTITUTE PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved
Date of registration: 24 Oct 2007 (18 years ago)
Financial Date End: 31 Oct 2014
Date dissolved: 21 Jan 2014
Entity Number: 214648
Place of Formation: IDAHO
File Number: 0000214648
ZIP code: 83404
County: Bonneville County
Principal Address: 2105 CORONADO ST IDAHO FALLS, ID 83404

National Provider Identifier

NPI Number:
1851571376

Authorized Person:

Name:
DR. SHANE MANGRUM
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
174400000X - Specialist
Is Primary:
Yes

Contacts:

Fax:
2085354344

Filing

Filing Name Filing Number Filing date
Statement of Dissolution 0000801667 2014-01-21
Annual Report 0001778901 2013-11-12
Annual Report 0001778900 2012-10-29
Annual Report 0001778899 2011-10-31
Annual Report 0001778898 2010-11-01

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Date of last update: 24 Sep 2024

Sources: Idaho Secretary of State