Provider Demographics
NPI:1285607762
Name:COWAN, JOHN STEPHEN (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STEPHEN
Last Name:COWAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7139 PERRY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-1655
Mailing Address - Country:US
Mailing Address - Phone:248-343-6111
Mailing Address - Fax:
Practice Address - Street 1:6507 TOWN CENTER DR
Practice Address - Street 2:SUITE F
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-4826
Practice Address - Country:US
Practice Address - Phone:248-625-7600
Practice Address - Fax:248-625-2772
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002754111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F327730OtherBCBSM
MI142114860Medicaid
MI142114860Medicaid
MI950F327730OtherBCBSM