Provider Demographics
NPI:1437939139
Name:COWAN, TREVENE RAVEN (DC)
Entity Type:Individual
Prefix:
First Name:TREVENE
Middle Name:RAVEN
Last Name:COWAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6935 OLD CANTON RD STE A
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1284
Mailing Address - Country:US
Mailing Address - Phone:601-956-6050
Mailing Address - Fax:601-952-0738
Practice Address - Street 1:6935 OLD CANTON RD STE A
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1284
Practice Address - Country:US
Practice Address - Phone:601-956-6050
Practice Address - Fax:601-952-0738
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor