Provider Demographics
NPI:1699876565
Name:SOWERS, KENNETH HAROLD (DC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:HAROLD
Last Name:SOWERS
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 1:112 E COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-2921
Mailing Address - Country:US
Mailing Address - Phone:501-215-4896
Mailing Address - Fax:501-215-4897
Practice Address - Street 1:112 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-2921
Practice Address - Country:US
Practice Address - Phone:501-215-4896
Practice Address - Fax:501-215-4897
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102749718Medicaid
AR59853Medicare ID - Type Unspecified
AR102749718Medicaid