Provider Demographics
NPI:1477928687
Name:BOWMAN CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:BOWMAN CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-362-0811
Mailing Address - Street 1:5219 PETERS CREEK RD NW STE 5
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-3870
Mailing Address - Country:US
Mailing Address - Phone:540-362-0811
Mailing Address - Fax:540-362-5025
Practice Address - Street 1:5219 PETERS CREEK RD NW STE 5
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-3870
Practice Address - Country:US
Practice Address - Phone:540-362-0811
Practice Address - Fax:540-362-5025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty