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General NPI Number Information
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NPI Number | 1790300598
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Entity Type | Organization
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Legal Business Name | VANCORP LLC
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 06/09/2020
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Provider Practice Location Address
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Address Line | 270 W GEORGIA AVE STE 110
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City | NAMPA
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State | ID
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Zip | 83686-2835
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Country | US
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Telephone | 208-724-4125
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Fax |
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Provider Business Mailing Address
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Address Line | 270 W GEORGIA AVE STE 110
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City | NAMPA
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State | ID
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Zip | 83686-2835
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/MEMBER
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Name | BETHANY VANCE
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Credential |
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Telephone | 208-724-4125
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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