Provider Demographics
NPI:1477736759
Name:CHINO VALLEY CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:CHINO VALLEY CHIROPRACTIC CLINIC
Other - Org Name:BOWEN CHIROPRACTIC AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:HOUSTON
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-636-7682
Mailing Address - Street 1:P.O. BOX 366
Mailing Address - Street 2:
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-5363
Mailing Address - Country:US
Mailing Address - Phone:928-636-7682
Mailing Address - Fax:928-636-7683
Practice Address - Street 1:794 SOUTH HWY 89
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-5363
Practice Address - Country:US
Practice Address - Phone:928-636-7682
Practice Address - Fax:928-636-7683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1011111N00000X
AZ6062111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ62173Medicare PIN
AZU80498Medicare UPIN