Provider Demographics
NPI:1891153391
Name:BOWER, JACOB
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:BOWER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 12TH AVE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5015
Mailing Address - Country:US
Mailing Address - Phone:208-466-0200
Mailing Address - Fax:208-621-3140
Practice Address - Street 1:1601 12TH AVE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-5015
Practice Address - Country:US
Practice Address - Phone:208-466-0200
Practice Address - Fax:208-621-3140
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1618111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician