Provider Demographics
NPI:1235109406
Name:BOWERMAN, DANIEL S (DC, FACO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:S
Last Name:BOWERMAN
Suffix:
Gender:M
Credentials:DC, FACO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1507
Mailing Address - Country:US
Mailing Address - Phone:215-923-5577
Mailing Address - Fax:215-627-3530
Practice Address - Street 1:512 S 4TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1507
Practice Address - Country:US
Practice Address - Phone:215-923-5577
Practice Address - Fax:215-627-3530
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001839L111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2633236OtherAETNA
PA000614OtherHIGHMARK BLUE SHIELD
PA0060992000OtherKHPE HMO
PA0060992000OtherIBC PERSONAL CHOICE
PAJ000614OtherAMERIHEALTH ADMINISTRATOR
PA2633236OtherAETNA