Provider Demographics
NPI:1417596297
Name:DOWELL, DANA (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:DOWELL
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1767 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:GALIEN
Mailing Address - State:MI
Mailing Address - Zip Code:49113-9660
Mailing Address - Country:US
Mailing Address - Phone:773-822-9808
Mailing Address - Fax:
Practice Address - Street 1:1981 UNION CHURCH RD
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:NC
Practice Address - Zip Code:28326-7957
Practice Address - Country:US
Practice Address - Phone:910-947-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000031896207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC000044422044OtherBLUE CROSS BLUE SHIELD