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General NPI Number Information
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NPI Number | 1174927933
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Entity Type | Organization
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Legal Business Name | BOWER CHIROPRACTIC INC
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Dates
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Enumeration Date | 10/22/2014
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Last Update Date | 10/22/2014
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Provider Practice Location Address
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Address Line | 304 12TH AVE RD
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City | NAMPA
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State | ID
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Zip | 83686
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Country | US
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Telephone | 208-466-0200
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Fax | 208-463-0649
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Provider Business Mailing Address
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Address Line | 304 12TH AVE RD
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City | NAMPA
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State | ID
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Zip | 83686
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Country | US
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Telephone | 208-466-0200
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Fax | 208-463-0649
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. JACOB RAYMOND BOWER
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Credential | MS DC
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Telephone | 208-466-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | CHIA-1618
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License Number State | ID
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