Provider Demographics
NPI:1619012614
Name:BOWEN, ROBERT HOUSTON (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HOUSTON
Last Name:BOWEN
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:PO BOX 366
Mailing Address - Street 2:794 SOUTH HIGHWAY 89
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-0366
Mailing Address - Country:US
Mailing Address - Phone:928-636-7682
Mailing Address - Fax:928-636-7683
Practice Address - Street 1:794 S HWY 89
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-6357
Practice Address - Country:US
Practice Address - Phone:928-636-7682
Practice Address - Fax:928-636-7683
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6062111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0932300OtherBCBS
AZAZ0932300OtherBCBS
AZU80498Medicare UPIN