Provider Demographics
NPI:1710958525
Name:OWINGS, JOHN RUSSELL (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RUSSELL
Last Name:OWINGS
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 1:4310 LEONARD ST NW
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WALKER
Mailing Address - State:MI
Mailing Address - Zip Code:49534-8447
Mailing Address - Country:US
Mailing Address - Phone:616-453-0600
Mailing Address - Fax:616-453-4268
Practice Address - Street 1:4310 LEONARD ST NW
Practice Address - Street 2:SUITE 103
Practice Address - City:WALKER
Practice Address - State:MI
Practice Address - Zip Code:49534-8447
Practice Address - Country:US
Practice Address - Phone:616-453-0600
Practice Address - Fax:616-453-4268
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D15130OtherBCBS
MI120443OtherPERFERRED CHOICES PPO
MI1034022OtherASH
MI5489608OtherAETNA
MI5489608OtherAETNA
MIU67921Medicare UPIN