Provider Demographics
NPI:1033467725
Name:MCCOWN CHIROPRACTIC
Entity Type:Organization
Organization Name:MCCOWN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:MCCOWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-577-0294
Mailing Address - Street 1:1710 ALLEN STREET (MAILING PO BOX 809)
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:68626-0070
Mailing Address - Country:US
Mailing Address - Phone:360-577-0294
Mailing Address - Fax:360-577-2635
Practice Address - Street 1:1710 ALLEN STREET
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-0070
Practice Address - Country:US
Practice Address - Phone:360-577-0294
Practice Address - Fax:360-577-2635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty