Provider Demographics
NPI:1699947283
Name:BOWLES, J. BRIGHAM (LAC)
Entity type:Individual
Prefix:
First Name:J.
Middle Name:BRIGHAM
Last Name:BOWLES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:BRIGHAM
Other - Middle Name:
Other - Last Name:BOWLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:395 S END AVE APT 34C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10280-1110
Mailing Address - Country:US
Mailing Address - Phone:646-683-6694
Mailing Address - Fax:
Practice Address - Street 1:395 S END AVE APT 34C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10280-1110
Practice Address - Country:US
Practice Address - Phone:646-683-6694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5493171100000X
NY001714171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001714OtherNY OFFICE PROFESSIONS