Provider Demographics
NPI:1063463735
Name:LOWERY, DONALD W (DC)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:W
Last Name:LOWERY
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:PO BOX 49307
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32240-9307
Mailing Address - Country:US
Mailing Address - Phone:904-783-0008
Mailing Address - Fax:904-783-0508
Practice Address - Street 1:5222 LENOX AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-4838
Practice Address - Country:US
Practice Address - Phone:904-783-0008
Practice Address - Fax:904-783-0508
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7883111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262769518OtherTAX I.D. NUMBER
53989Medicare ID - Type Unspecified
FL262769518OtherTAX I.D. NUMBER