Provider Demographics
NPI:1992939763
Name:RICHARD K SOWERBY DC PLLC
Entity type:Organization
Organization Name:RICHARD K SOWERBY DC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:SOWERBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-879-1900
Mailing Address - Street 1:1953 SOUTH BLVD W
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-1786
Mailing Address - Country:US
Mailing Address - Phone:248-879-1900
Mailing Address - Fax:248-879-7305
Practice Address - Street 1:1953 SOUTH BLVD W
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-1786
Practice Address - Country:US
Practice Address - Phone:248-879-1900
Practice Address - Fax:248-879-7305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT32613Medicare UPIN