Provider Demographics
NPI:1396212098
Name:LOWRY, CHANCE RYAN SR (DC)
Entity Type:Individual
Prefix:DR
First Name:CHANCE
Middle Name:RYAN
Last Name:LOWRY
Suffix:SR
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 1:452 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1352
Mailing Address - Country:US
Mailing Address - Phone:315-789-0343
Mailing Address - Fax:315-789-0345
Practice Address - Street 1:452 W NORTH ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1352
Practice Address - Country:US
Practice Address - Phone:315-789-0343
Practice Address - Fax:315-789-0345
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX01353-1111N00000X
NYX013153-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor