Provider Demographics
NPI:1568802056
Name:MIMS, LAUREN MARIE (DC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:MIMS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 W CHERRY LN
Mailing Address - Street 2:STE 130
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8187
Mailing Address - Country:US
Mailing Address - Phone:208-895-8595
Mailing Address - Fax:208-895-8594
Practice Address - Street 1:2703 MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402
Practice Address - Country:US
Practice Address - Phone:903-494-5101
Practice Address - Fax:208-895-8594
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1555111N00000X
TX13093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor