Provider Demographics
NPI:1376541557
Name:FOWLER, KATHLEEN M (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:M
Last Name:FOWLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 E MAIN ST
Mailing Address - Street 2:STE 4
Mailing Address - City:MERRIMAC
Mailing Address - State:MA
Mailing Address - Zip Code:01860-2005
Mailing Address - Country:US
Mailing Address - Phone:978-346-4450
Mailing Address - Fax:978-346-4334
Practice Address - Street 1:5 E MAIN ST
Practice Address - Street 2:STE 4
Practice Address - City:MERRIMAC
Practice Address - State:MA
Practice Address - Zip Code:01860-2005
Practice Address - Country:US
Practice Address - Phone:978-346-4450
Practice Address - Fax:978-346-4334
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1493111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA44-00508OtherUNITED HEALTH CARE
MA72811OtherTUFTS PROVIDER NUMBER
MAY36022OtherBC PROVIDER NUMBER
MA110030385AMedicaid
MAAA29332OtherHARVARD PILGRIM PROV #
MA562020OtherAETNA USHC PROVIDER #
MAY39270OtherBC/BS GROUP NUMBER