Provider Demographics
NPI:1558368951
Name:FOWLER, PAUL JEFFREY (DC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JEFFREY
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 1:30 MERRILL ST
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-4307
Mailing Address - Country:US
Mailing Address - Phone:978-388-2170
Mailing Address - Fax:978-388-7172
Practice Address - Street 1:30 MERRILL ST
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-4307
Practice Address - Country:US
Practice Address - Phone:978-388-2170
Practice Address - Fax:978-388-7172
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1357111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35972OtherBCBS
MA1610457Medicaid
MA1610457Medicaid