Provider Demographics
NPI:1225061112
Name:FOWLER, DAVID ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANDREW
Last Name:FOWLER
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 1:13028 INTERURBAN AVE S
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-3340
Mailing Address - Country:US
Mailing Address - Phone:206-957-7950
Mailing Address - Fax:206-957-7952
Practice Address - Street 1:13028 INTERURBAN AVE S
Practice Address - Street 2:SUITE 106
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-3340
Practice Address - Country:US
Practice Address - Phone:206-957-7950
Practice Address - Fax:206-957-7952
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27430111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0274300OtherBLUE SHIELD
CADC0274300Medicare ID - Type Unspecified
CADC0274300OtherBLUE SHIELD