Provider Demographics
NPI:1285927533
Name:BOW, CRAIG MATTHEW (DC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:MATTHEW
Last Name:BOW
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 1:625 N WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-4241
Mailing Address - Country:US
Mailing Address - Phone:941-356-3198
Mailing Address - Fax:
Practice Address - Street 1:625 N WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-4241
Practice Address - Country:US
Practice Address - Phone:941-356-3198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU75205Medicare UPIN