Organization
PRIME SPORTS MED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB BOWER DC (CHIROPRACTOR)
(208) 466-0200
Entity
Organization
Contact information
Practice address
1601 12TH AVE RD, SUITE 101, NAMPA, ID 83686-5015
(208) 466-0200
Mailing address
1601 12TH AVE RD, SUITE 101, NAMPA, ID 83686-5015
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-1618
ID
225100000X
Physical Therapist
—
—
Other
Enumeration date
01/24/2018
Last updated
05/25/2021
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