Provider Demographics
NPI:1568641538
Name:J KENNETH BOWMAN DC INC PC
Entity Type:Organization
Organization Name:J KENNETH BOWMAN DC INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-281-2844
Mailing Address - Street 1:SUITE F
Mailing Address - Street 2:311 MAPLE AVE WEST
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4309
Mailing Address - Country:US
Mailing Address - Phone:703-281-2844
Mailing Address - Fax:703-281-4967
Practice Address - Street 1:311 MAPLE AVE W
Practice Address - Street 2:SUITE F
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4309
Practice Address - Country:US
Practice Address - Phone:703-281-2844
Practice Address - Fax:703-281-4967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG02781Medicare PIN