Provider Demographics
NPI:1154517530
Name:BOWMAN CHIROPRACTIC
Entity type:Organization
Organization Name:BOWMAN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-547-4151
Mailing Address - Street 1:300 W 2ND S
Mailing Address - Street 2:
Mailing Address - City:SODA SPRINGS
Mailing Address - State:ID
Mailing Address - Zip Code:83276-1515
Mailing Address - Country:US
Mailing Address - Phone:208-547-4151
Mailing Address - Fax:208-547-4093
Practice Address - Street 1:300 W 2ND S
Practice Address - Street 2:
Practice Address - City:SODA SPRINGS
Practice Address - State:ID
Practice Address - Zip Code:83276-1515
Practice Address - Country:US
Practice Address - Phone:208-547-4151
Practice Address - Fax:208-547-4093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDC458111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC458-7OtherBLUE CROSS
IDC458-7OtherBLUE CROSS
IDT44481Medicare UPIN