Provider Demographics
NPI:1285907659
Name:FOWLER CHIROPRACTIC
Entity type:Organization
Organization Name:FOWLER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRELL
Authorized Official - Middle Name:E
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:843-374-8299
Mailing Address - Street 1:111 N MATTHEWS RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-2309
Mailing Address - Country:US
Mailing Address - Phone:843-374-8299
Mailing Address - Fax:843-374-2195
Practice Address - Street 1:111 N MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-2309
Practice Address - Country:US
Practice Address - Phone:843-374-8299
Practice Address - Fax:843-374-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1191Medicaid
SCT911300281Medicare PIN