Provider Demographics
NPI:1346432416
Name:FOWERS, BRETT WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:WAYNE
Last Name:FOWERS
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 1:921 EXECUTIVE PARK DR STE C
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-3549
Mailing Address - Country:US
Mailing Address - Phone:801-262-7325
Mailing Address - Fax:801-305-4963
Practice Address - Street 1:921 EXECUTIVE PARK DR STE C
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-3549
Practice Address - Country:US
Practice Address - Phone:801-262-7325
Practice Address - Fax:801-305-4963
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT49526861202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor