Provider Demographics
NPI:1992870596
Name:BOWLES, SCOT D (DC)
Entity type:Individual
Prefix:DR
First Name:SCOT
Middle Name:D
Last Name:BOWLES
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 1:7690 SW ROANOKE DR S
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-6810
Mailing Address - Country:US
Mailing Address - Phone:503-582-1025
Mailing Address - Fax:
Practice Address - Street 1:1163 MOLALLA AVE
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-3741
Practice Address - Country:US
Practice Address - Phone:503-650-3737
Practice Address - Fax:503-650-3747
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU99395Medicare UPIN
OR132572Medicare ID - Type Unspecified