Provider Demographics
NPI:1477663623
Name:GOWEN CHIROPRACTIC AND REHABILITATION, INC
Entity Type:Organization
Organization Name:GOWEN CHIROPRACTIC AND REHABILITATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-342-5663
Mailing Address - Street 1:2909 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-6272
Mailing Address - Country:US
Mailing Address - Phone:620-342-5663
Mailing Address - Fax:620-342-5663
Practice Address - Street 1:2909 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-6272
Practice Address - Country:US
Practice Address - Phone:620-342-5663
Practice Address - Fax:620-342-5663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04614111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS660027OtherBLUE CROSS ID