Individual
DR. JUSTIN RAY CLEVERLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
800 MAIN ST, BUHL, ID 83316-1236
(208) 543-2005
(208) 543-4172
Mailing address
800 MAIN ST, BUHL, ID 83316-1236
(208) 543-2005
(208) 543-4172
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-902
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010027755
REGENCE BLUE SHIELD
ID
05
—
805752600
—
ID
01
—
C1575
BLUE CROSS
ID
Enumeration date
09/23/2005
Last updated
03/27/2013
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