Provider Demographics
NPI:1225334980
Name:BOWER, SAMANTHA LOVE (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:LOVE
Last Name:BOWER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SAMANTHA
Other - Middle Name:LOVE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3356 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-4103
Mailing Address - Country:US
Mailing Address - Phone:570-447-5688
Mailing Address - Fax:
Practice Address - Street 1:680 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-3119
Practice Address - Country:US
Practice Address - Phone:570-560-3417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2018-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010395111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA219363Q0VMedicare UPIN