Provider Demographics
NPI:1679674881
Name:SOWERBY, RICHARD K (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:K
Last Name:SOWERBY
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 1:1953 SOUTH BLVD W
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-1786
Mailing Address - Country:US
Mailing Address - Phone:248-879-1900
Mailing Address - Fax:
Practice Address - Street 1:1953 SOUTH BLVD W
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-1786
Practice Address - Country:US
Practice Address - Phone:248-879-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005328111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0004641345OtherAETNA
MI0004641345OtherAETNA
MI0N46940Medicare ID - Type UnspecifiedMEDICARE