Provider Demographics
NPI:1083610208
Name:BOWEN, MICHAEL JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:BOWEN
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 1:11110 ARTESIA BLVD
Mailing Address - Street 2:STE G
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2546
Mailing Address - Country:US
Mailing Address - Phone:562-402-4848
Mailing Address - Fax:562-402-0258
Practice Address - Street 1:11110 ARTESIA BLVD
Practice Address - Street 2:STE G
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2546
Practice Address - Country:US
Practice Address - Phone:562-402-4848
Practice Address - Fax:562-402-0258
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2008-01-16
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
CADC15141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0151410Medicare ID - Type Unspecified