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General NPI Number Information
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NPI Number | 1336305184
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Entity Type | Organization
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Legal Business Name | BUENA VISTA ENTERPRISES, INC.
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Dates
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Enumeration Date | 07/31/2008
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 2007 N WHITLEY DR
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City | FRUITLAND
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State | ID
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Zip | 83619-2132
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Country | US
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Telephone | 208-452-4455
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Fax | 208-452-3025
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Provider Business Mailing Address
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Address Line | 2007 N WHITLEY DR
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City | FRUITLAND
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State | ID
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Zip | 83619-2132
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Country | US
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Telephone | 208-452-4455
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Fax | 208-452-3025
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Authorized Official
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Title or Position | MANAGER
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Name | DR. DAVID V. OWENS
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Credential | D.C.
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Telephone | 208-452-4455
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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 | CHIA-703
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License Number State | ID
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