Provider Demographics
NPI:1063473858
Name:FOWLER, MONICA L (DC)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:L
Last Name:FOWLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:L
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:7455 W TWIN PEAKS RD
Mailing Address - Street 2:STE 111
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-1543
Mailing Address - Country:US
Mailing Address - Phone:520-579-7906
Mailing Address - Fax:520-579-7912
Practice Address - Street 1:8245 N SILVERBELL RD
Practice Address - Street 2:SUITE 159
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-7381
Practice Address - Country:US
Practice Address - Phone:520-579-7906
Practice Address - Fax:520-579-7912
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3033111N00000X
AZ8221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH3033Medicaid
SCCH3033Medicaid