Provider Demographics
NPI:1558836403
Name:BOWMAN CHIROPRACTIC S.C.
Entity Type:Organization
Organization Name:BOWMAN CHIROPRACTIC S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-453-2515
Mailing Address - Street 1:417 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-1352
Mailing Address - Country:US
Mailing Address - Phone:715-453-2515
Mailing Address - Fax:715-453-1900
Practice Address - Street 1:417 N 4TH ST
Practice Address - Street 2:
Practice Address - City:TOMAHAWK
Practice Address - State:WI
Practice Address - Zip Code:54487-1352
Practice Address - Country:US
Practice Address - Phone:715-453-2515
Practice Address - Fax:715-453-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-08
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100080908Medicaid