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Individual

MRS. LAURA MARIE JOHNSON STEVENSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
BS DC CCEP

Contact information

Practice address
600 N LINCOLN AVE, JEROME, ID 83338-1850
(208) 324-3730
(208) 324-5512
Mailing address
600 N LINCOLN AVE, JEROME, ID 83338-1850
(208) 324-3730
(208) 324-5512

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIRO584
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10019692
BLUE SHIELD
ID
01
C5681
BLUE CROSS OF IDAHO
ID
Enumeration date
11/01/2006
Last updated
01/28/2008
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