Provider Demographics
NPI:1417433590
Name:BOWER, DANIELLE (LAC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BOWER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 E 38TH 1/2 ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78722-1821
Mailing Address - Country:US
Mailing Address - Phone:512-452-1410
Mailing Address - Fax:
Practice Address - Street 1:1307 E 38TH 1/2 ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78722-1821
Practice Address - Country:US
Practice Address - Phone:512-452-1410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01829171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist