Provider Demographics
NPI:1619144938
Name:BULOW, IAN (DC)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:
Last Name:BULOW
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 1:168 JAMESON WAY
Mailing Address - Street 2:
Mailing Address - City:SEVEN FIELDS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-4350
Mailing Address - Country:US
Mailing Address - Phone:724-553-8526
Mailing Address - Fax:
Practice Address - Street 1:20808 ROUTE 19
Practice Address - Street 2:SUITE C
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-6022
Practice Address - Country:US
Practice Address - Phone:724-553-8526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor