Provider Demographics
NPI:1497766307
Name:OWENS, BRENT A (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:A
Last Name:OWENS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9380 MONTGOMERY RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7753
Mailing Address - Country:US
Mailing Address - Phone:513-891-7746
Mailing Address - Fax:513-891-7747
Practice Address - Street 1:9380 MONTGOMERY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7753
Practice Address - Country:US
Practice Address - Phone:513-891-7746
Practice Address - Fax:513-891-7747
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0203324OtherLABOR AND INDUSTRIES
WA912103660OtherTAX ID
WACH00034524OtherSTATE LICENSE
WAV08214Medicare UPIN
WA8858156Medicare ID - Type Unspecified