Provider Demographics
NPI:1619930583
Name:MCCOWN, NANCY ANN (DC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:MCCOWN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 VANDERCOOK WAY STE 101A
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-4050
Mailing Address - Country:US
Mailing Address - Phone:360-577-0294
Mailing Address - Fax:360-577-2635
Practice Address - Street 1:755 VANDERCOOK WAY STE 101A
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4050
Practice Address - Country:US
Practice Address - Phone:360-577-0294
Practice Address - Fax:360-577-2635
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA350017103Medicaid
WA2005866OtherHMO
WA10436OtherWA L&I
WA10436OtherWA L&I