Individual
DR. PATRICK TERRY MAYO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
3298 E 17TH STREET, IDAHO FALLS, ID 83406
(208) 522-3863
(208) 522-3863
Mailing address
3298 E 17TH STREET, IDAHO FALLS, ID 83406
(208) 522-3863
(208) 522-3863
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA434
ID
171100000X
Acupuncturist
ACC79
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010008923
REGENCE BLUE SHIELD
—
01
—
C4348
BLUE CROSS
—
Enumeration date
10/23/2006
Last updated
09/28/2010
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