Provider Demographics
NPI:1528207834
Name:BOWDEN CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:BOWDEN CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:VERNAL
Authorized Official - Last Name:BOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-547-9974
Mailing Address - Street 1:116 N ADAMSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040
Mailing Address - Country:US
Mailing Address - Phone:801-547-9974
Mailing Address - Fax:801-547-9949
Practice Address - Street 1:116 N ADAMSWOOD RD
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040
Practice Address - Country:US
Practice Address - Phone:801-547-9974
Practice Address - Fax:801-547-9949
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOWDEN CHIROPRACTIC CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT85-172995-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT518520911017Medicaid
UT518520911017Medicaid
UT000005795Medicare PIN