OrganizationActive
Idaho Sports & Spine PLLC
NPI 1033417035 · Sports Medicine (Family Medicine) Physician · Pocatello, ID
Provider details
- NPI number
- 1033417035
- Entity type
- Organization
- Primary specialty
- Sports Medicine (Family Medicine) PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Stephen Hansen, Owner(208) 478-4522
- License
- O-0400 (ID)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
950 Hospital Way
Ste a
Pocatello, ID 83201-2789
Phone: (208) 478-4522
Fax: (208) 478-2935
Approximate (ZIP-level) locationGet directions
Mailing address
950 Hospital Way
Pocatello, ID 83201-2789
Other names (DBA / former)
- Former legal business name
- Christopher R Johnson DO, PLLC
Registry dates
- Enumerated
- 2011-03-01
- Last updated
- 2019-11-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.