Provider Demographics
NPI:1487003935
Name:BOWERS, RENNES IV
Entity Type:Individual
Prefix:
First Name:RENNES
Middle Name:
Last Name:BOWERS
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6023 N DIXIE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-4017
Mailing Address - Country:US
Mailing Address - Phone:937-454-2048
Mailing Address - Fax:937-454-9416
Practice Address - Street 1:6023 N DIXIE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-4017
Practice Address - Country:US
Practice Address - Phone:937-454-2048
Practice Address - Fax:937-454-9416
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor