Provider Demographics
NPI:1073738951
Name:OWENS, JOHN STANLEY (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:STANLEY
Last Name:OWENS
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 325
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425-0325
Mailing Address - Country:US
Mailing Address - Phone:850-547-2244
Mailing Address - Fax:850-547-2422
Practice Address - Street 1:1604 S WAUKESHA ST
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-3112
Practice Address - Country:US
Practice Address - Phone:850-547-2244
Practice Address - Fax:850-547-2422
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3307111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT96757Medicare UPIN
FL88461Medicare ID - Type Unspecified