Provider Demographics
NPI:1548378326
Name:FOWLER, REX WAYNE (DC)
Entity Type:Individual
Prefix:
First Name:REX
Middle Name:WAYNE
Last Name:FOWLER
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 1:156 W. UNIVERSITY PARKWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305
Mailing Address - Country:US
Mailing Address - Phone:731-664-5681
Mailing Address - Fax:731-664-5393
Practice Address - Street 1:156 W. UNIVERSITY PARKWAY
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305
Practice Address - Country:US
Practice Address - Phone:731-664-5681
Practice Address - Fax:731-664-5393
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3671351Medicaid
T74783Medicare UPIN
3671351Medicare ID - Type Unspecified