Provider Demographics
NPI:1528792983
Name:BOWEN, CHOC JR (LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:CHOC
Middle Name:
Last Name:BOWEN
Suffix:JR
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-2164
Mailing Address - Country:US
Mailing Address - Phone:520-820-7539
Mailing Address - Fax:
Practice Address - Street 1:1005 DUKE DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-1299
Practice Address - Country:US
Practice Address - Phone:402-362-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer