Provider Demographics
NPI:1255493631
Name:OWENS, DAVID VAL (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:VAL
Last Name:OWENS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 N WHITLEY DR
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-2132
Mailing Address - Country:US
Mailing Address - Phone:208-452-4455
Mailing Address - Fax:208-452-3025
Practice Address - Street 1:2007 N WHITLEY DR
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2132
Practice Address - Country:US
Practice Address - Phone:208-452-4455
Practice Address - Fax:208-452-3025
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC7036OtherBLUE CROSS
IDT42006OtherMOST OTHERS
ID000010006845OtherBLUE SHIELD
ID000010006845OtherBLUE SHIELD