Provider Demographics
NPI:1245727593
Name:RUVALCABA, MARCO ANTONIO (DC)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:ANTONIO
Last Name:RUVALCABA
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 1:3223 E LOUISE AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:208-466-0200
Mailing Address - Fax:208-648-4086
Practice Address - Street 1:3223 E LOUISE AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642
Practice Address - Country:US
Practice Address - Phone:208-466-0200
Practice Address - Fax:208-648-4086
Is Sole Proprietor?:No
Enumeration Date:2018-04-21
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6461971111N00000X
CA34180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor