Provider Demographics
NPI:1316154511
Name:LOWERY, WADE LEE (DC)
Entity type:Individual
Prefix:DR
First Name:WADE
Middle Name:LEE
Last Name:LOWERY
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 1:4829 E BELTLINE AVE NE
Mailing Address - Street 2:STE. 304
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9747
Mailing Address - Country:US
Mailing Address - Phone:616-874-0874
Mailing Address - Fax:
Practice Address - Street 1:4829 E BELTLINE AVE NE
Practice Address - Street 2:STE 304
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9747
Practice Address - Country:US
Practice Address - Phone:616-874-0874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007697111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1316154511OtherNPI
MIWL007697OtherBCBS
MI1316154511OtherNPI
MI0M67760Medicare ID - Type Unspecified