Provider Demographics
NPI:1154518058
Name:BOWDEN FAMILY CHIROPRACTIC PC
Entity type:Organization
Organization Name:BOWDEN FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-287-5200
Mailing Address - Street 1:387 STIRLING VLG
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-6720
Mailing Address - Country:US
Mailing Address - Phone:724-287-5200
Mailing Address - Fax:
Practice Address - Street 1:387 STIRLING VLG
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-6720
Practice Address - Country:US
Practice Address - Phone:724-287-5200
Practice Address - Fax:724-287-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-008003-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABO999697OtherHIGHMARK
PAU91630Medicare UPIN
PA061191Medicare PIN