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General NPI Number Information
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NPI Number | 1891153391
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Entity Type | Individual
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Provider Name | JACOB BOWER
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Gender | Male
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Dates
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Enumeration Date | 01/29/2016
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 1601 12TH AVE RD SUITE 101
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City | NAMPA
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State | ID
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Zip | 83686-5015
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Country | US
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Telephone | 208-466-0200
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Fax | 208-621-3140
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Provider Business Mailing Address
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Address Line | 1601 12TH AVE RD SUITE 101
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City | NAMPA
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State | ID
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Zip | 83686-5015
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Country | US
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Telephone | 208-466-0200
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Fax | 208-621-3140
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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 | 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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