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Organization
IDAHO SPORTS & SPINE PLLC
Active
Organization
IDAHO SPORTS & SPINE PLLC
Active
Other names
Christopher R Johnson DO, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN HANSEN D.O. (OWNER)
(208) 478-4522
Entity
Organization
Contact information
Practice address
950 HOSPITAL WAY, STE A, POCATELLO, ID 83201-2789
(208) 478-4522
(208) 478-2935
Mailing address
950 HOSPITAL WAY, STE A, POCATELLO, ID 83201-2789
(208) 478-4522
(208) 478-2935
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
O-0400
ID
Other
Enumeration date
03/01/2011
Last updated
11/04/2019
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