Provider Demographics
NPI:1508043282
Name:BOWMAN, THEODORE THOMAS JR (DC)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:THOMAS
Last Name:BOWMAN
Suffix:JR
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 1:1376 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1519
Mailing Address - Country:US
Mailing Address - Phone:404-373-0400
Mailing Address - Fax:
Practice Address - Street 1:1376 CHURCH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1519
Practice Address - Country:US
Practice Address - Phone:404-373-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003002111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor