Provider Demographics
NPI:1134681877
Name:BOWMAN, JEREMY A (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:A
Last Name:BOWMAN
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 1:365A E BLACKSTOCK RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-3762
Mailing Address - Country:US
Mailing Address - Phone:864-574-4862
Mailing Address - Fax:864-587-6858
Practice Address - Street 1:365A E BLACKSTOCK RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-3762
Practice Address - Country:US
Practice Address - Phone:864-574-4862
Practice Address - Fax:864-587-6858
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25562255A2300X
SC4402111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4402OtherSOUTH CAROLINA DEPT. OF LABOR, LICENSING AND REGULATION