Provider Demographics
NPI:1093851677
Name:BOWERS, HOMER LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:HOMER
Middle Name:LEE
Last Name:BOWERS
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 1:770 GOUCHER ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-2661
Mailing Address - Country:US
Mailing Address - Phone:814-255-1818
Mailing Address - Fax:814-255-2516
Practice Address - Street 1:770 GOUCHER ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-2661
Practice Address - Country:US
Practice Address - Phone:814-255-1818
Practice Address - Fax:814-255-2516
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001340L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000620240001Medicaid
B011608Medicare ID - Type Unspecified