Provider Demographics
NPI:1730281015
Name:BOWMAN JORDAN, KELLI (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:
Last Name:BOWMAN JORDAN
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 1:100 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654
Mailing Address - Country:US
Mailing Address - Phone:830-693-1985
Mailing Address - Fax:830-693-8167
Practice Address - Street 1:100 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654
Practice Address - Country:US
Practice Address - Phone:830-693-1985
Practice Address - Fax:830-693-8167
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4973111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX602059OtherBCBS