Provider Demographics
NPI:1104837350
Name:BOWKER CLINIC OF CHIROPRACTIC AND SPORTS MEDICINE
Entity Type:Organization
Organization Name:BOWKER CLINIC OF CHIROPRACTIC AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOWKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-541-6400
Mailing Address - Street 1:7005 SHANNON WILLOW RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-1300
Mailing Address - Country:US
Mailing Address - Phone:704-541-6400
Mailing Address - Fax:704-541-4169
Practice Address - Street 1:7005 SHANNON WILLOW RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-1300
Practice Address - Country:US
Practice Address - Phone:704-541-6400
Practice Address - Fax:704-541-4169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0826AOtherBLUE CROSS BLUE SHEILD
NC=========OtherTAX ID
NC=========OtherTAX ID