Provider Demographics
NPI:1396134516
Name:FOWLER, CHASE LEE (DC)
Entity type:Individual
Prefix:DR
First Name:CHASE
Middle Name:LEE
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 1:350 BLACKWELL RD
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29702-9699
Mailing Address - Country:US
Mailing Address - Phone:864-491-0880
Mailing Address - Fax:
Practice Address - Street 1:222 E BLACKSTOCK RD
Practice Address - Street 2:SUITE D
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-2627
Practice Address - Country:US
Practice Address - Phone:864-574-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor