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Individual

DR. LUKE CORONE MAYES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DC

Contact information

Practice address
5975 W OVERLAND RD, BOISE, ID 83709-3012
(208) 375-9000
(208) 375-9032
Mailing address
12166 W PATRINA DR, BOISE, ID 83713-1016
(208) 375-9000
(208) 375-9032

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-981
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
334226
BLUE SHIELD #
ID
05
8067623
ID
01
C2631
BLUE CROSS #
ID
Enumeration date
12/01/2006
Last updated
07/09/2007
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