Provider Demographics
NPI:1619373149
Name:BOWERMAN, MICHAEL T JR (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:BOWERMAN
Suffix:JR
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 1:2919 LAKE PINELOCH BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-5575
Mailing Address - Country:US
Mailing Address - Phone:407-446-6687
Mailing Address - Fax:
Practice Address - Street 1:13802 LANDSTAR BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-5500
Practice Address - Country:US
Practice Address - Phone:407-446-6687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-11
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH1137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor