Provider Demographics
NPI:1760603211
Name:DAREN D. BOWLBY DC PS
Entity Type:Organization
Organization Name:DAREN D. BOWLBY DC PS
Other - Org Name:BOWLBY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWLBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-575-8897
Mailing Address - Street 1:1157 3RD AVE
Mailing Address - Street 2:SUITE 145
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-6000
Mailing Address - Country:US
Mailing Address - Phone:360-575-8897
Mailing Address - Fax:360-575-8898
Practice Address - Street 1:1157 3RD AVE
Practice Address - Street 2:SUITE 145
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-6000
Practice Address - Country:US
Practice Address - Phone:360-575-8897
Practice Address - Fax:360-575-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003502111N00000X
WACH00034742111N00000X
WAMA00018977225700000X
WAMA00023535225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0185824OtherLABOR & INDUSTRIES GROUP
WAU68308Medicare UPIN
WA8852886Medicare ID - Type UnspecifiedGROUP NUMBER