Provider Demographics
NPI:1750508941
Name:OWENS, WILLIAM WADE (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WADE
Last Name:OWENS
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 1:691 EAST CHERRY ST.
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63343
Mailing Address - Country:US
Mailing Address - Phone:636-528-8291
Mailing Address - Fax:
Practice Address - Street 1:691 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-1411
Practice Address - Country:US
Practice Address - Phone:636-528-8291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU59265Medicare UPIN