Provider Demographics
NPI:1427038462
Name:BOWERS, MARK WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WAYNE
Last Name:BOWERS
Suffix:
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 1:37342 WEYMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4096
Mailing Address - Country:US
Mailing Address - Phone:734-464-6489
Mailing Address - Fax:
Practice Address - Street 1:216 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1918
Practice Address - Country:US
Practice Address - Phone:248-685-2623
Practice Address - Fax:248-684-9013
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002799111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F35081OtherBLUE CROSS BLUE SHIELD
MI950F35081OtherBLUE CROSS BLUE SHIELD