Individual
DR. GARY L JOHNSON II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
2745 POLE LINE ROAD, POCATELLO, ID 83201-6111
(208) 234-2225
(208) 478-5556
Mailing address
2745 POLE LINE ROAD, POCATELLO, ID 83201-6111
(208) 234-2225
(208) 478-5556
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA -958
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010034427
BLUE SHIELD ID
ID
01
—
C2284
BLUE CROSS ID
ID
Enumeration date
01/03/2007
Last updated
03/12/2024
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