Provider Demographics
NPI:1093883639
Name:MAYES, LUKE CORONE (DC)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:CORONE
Last Name:MAYES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12166 W PATRINA DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1016
Mailing Address - Country:US
Mailing Address - Phone:208-375-9000
Mailing Address - Fax:208-375-9032
Practice Address - Street 1:5975 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-3012
Practice Address - Country:US
Practice Address - Phone:208-375-9000
Practice Address - Fax:208-375-9032
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID334226OtherBLUE SHIELD #
IDC2631OtherBLUE CROSS #
ID8067623Medicaid
ID334226OtherBLUE SHIELD #
ID1674946Medicare ID - Type Unspecified