Provider Demographics
NPI:1306062062
Name:COWAN, MATTHEW BRIAN (ND)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRIAN
Last Name:COWAN
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 CHERRY HILL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5921
Mailing Address - Country:US
Mailing Address - Phone:573-447-1225
Mailing Address - Fax:573-447-1225
Practice Address - Street 1:2024 CHERRY HILL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5921
Practice Address - Country:US
Practice Address - Phone:573-447-1225
Practice Address - Fax:573-447-1225
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1383175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath