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General NPI Number Information
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NPI Number | 1245727593
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Entity Type | Individual
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Provider Name | MARCO ANTONIO RUVALCABA DC
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Gender | Male
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Dates
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Enumeration Date | 04/21/2018
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 3223 E LOUISE AVE SUITE 110
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City | MERIDIAN
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State | ID
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Zip | 83642
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Country | US
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Telephone | 208-466-0200
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Fax | 208-648-4086
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Provider Business Mailing Address
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Address Line | 3223 E LOUISE AVE SUITE 110
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City | MERIDIAN
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State | ID
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Zip | 83642
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Country | US
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Telephone | 208-466-0200
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Fax | 208-648-4086
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6461971
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 34180
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License Number State | CA
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