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General NPI Number Information
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NPI Number | 1891821369
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Entity Type | Individual
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Provider Name | MIKEAL BRUCE NAVE DC
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Gender | Male
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 05/26/2011
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Provider Practice Location Address
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Address Line | 108 E 6TH ST
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City | EMMETT
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State | ID
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Zip | 83617-3536
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Country | US
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Telephone | 208-365-6300
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Fax | 208-365-6309
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Provider Business Mailing Address
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Address Line | 108 E 6TH ST
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City | EMMETT
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State | ID
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Zip | 83617-3536
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Country | US
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Telephone | 208-365-6300
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Fax | 208-365-6309
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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 | DC15672
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License Number State | CA
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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 | CHIA-1417
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License Number State | ID
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