Provider Demographics
NPI:1366554834
Name:FOWLER, CHRISTOPHER SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:SCOTT
Last Name:FOWLER
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:PO BOX 1526
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39043-1526
Mailing Address - Country:US
Mailing Address - Phone:601-932-1070
Mailing Address - Fax:601-932-9020
Practice Address - Street 1:5230 HIGHWAY 80 E
Practice Address - Street 2:SUITE A
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-8921
Practice Address - Country:US
Practice Address - Phone:601-932-1070
Practice Address - Fax:601-932-9020
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125702Medicaid
MSU88007Medicare UPIN