Organization
VANCORP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETHANY VANCE (CEO/MEMBER)
(208) 724-4125
Entity
Organization
Contact information
Practice address
270 W GEORGIA AVE STE 110, NAMPA, ID 83686-2835
(208) 724-4125
Mailing address
270 W GEORGIA AVE STE 110, NAMPA, ID 83686-2835
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
225100000X
Physical Therapist
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/08/2020
Last updated
06/09/2020
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