Provider Demographics
NPI:1336305184
Name:BUENA VISTA ENTERPRISES, INC.
Entity Type:Organization
Organization Name:BUENA VISTA ENTERPRISES, INC.
Other - Org Name:OWENS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:V
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-452-4455
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010006845OtherBLUE SHIELD
IDC7036OtherBLUE CROSS
IDT42006OtherMOST OTHERS
IDT42006OtherMOST OTHERS