Provider Demographics
NPI:1053668889
Name:OWC, INC.
Entity Type:Organization
Organization Name:OWC, INC.
Other - Org Name:OROFINO WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:J
Authorized Official - Last Name:POPOVICS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-476-7091
Mailing Address - Street 1:830 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-7005
Mailing Address - Country:US
Mailing Address - Phone:208-476-7091
Mailing Address - Fax:866-993-2828
Practice Address - Street 1:830 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-7005
Practice Address - Country:US
Practice Address - Phone:208-476-7091
Practice Address - Fax:866-993-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-10
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1515111N00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty