Provider Demographics
NPI:1659603645
Name:BOWMAN, WESLEY MICHAEL (DC)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:MICHAEL
Last Name:BOWMAN
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 327
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-0327
Mailing Address - Country:US
Mailing Address - Phone:928-536-4826
Mailing Address - Fax:928-536-5213
Practice Address - Street 1:1083 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5582
Practice Address - Country:US
Practice Address - Phone:928-536-4826
Practice Address - Fax:928-536-5213
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor