Provider Demographics
NPI:1679015473
Name:BOWEN-AITKENS, DESHAWN EDWARD (LMP)
Entity Type:Individual
Prefix:
First Name:DESHAWN
Middle Name:EDWARD
Last Name:BOWEN-AITKENS
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3236 78TH AVE SE
Mailing Address - Street 2:#100
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3500
Mailing Address - Country:US
Mailing Address - Phone:206-232-6653
Mailing Address - Fax:206-551-5333
Practice Address - Street 1:3236 78TH AVE SE
Practice Address - Street 2:#100
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3500
Practice Address - Country:US
Practice Address - Phone:206-232-6653
Practice Address - Fax:206-551-5333
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60605800111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation