Provider Demographics
NPI:1386658169
Name:MOWER, ROBERTA (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:
Last Name:MOWER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:BOBBIE
Other - Middle Name:
Other - Last Name:MOWER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1061
Mailing Address - Street 2:7160 SW HAZELERN ROAD
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-1061
Mailing Address - Country:US
Mailing Address - Phone:503-620-6480
Mailing Address - Fax:503-684-4598
Practice Address - Street 1:7160 SW HAZELFERN RD
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062
Practice Address - Country:US
Practice Address - Phone:503-620-6480
Practice Address - Fax:503-684-4598
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-1773111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000QGCKWMedicare ID - Type Unspecified
ORT67936Medicare UPIN