Provider Demographics
NPI:1780686576
Name:MOWRY, ANDREW L (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:L
Last Name:MOWRY
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 1:240 N LIBERTY ST
Mailing Address - Street 2:SUITE R
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7804
Mailing Address - Country:US
Mailing Address - Phone:614-436-9070
Mailing Address - Fax:614-436-8803
Practice Address - Street 1:240 N LIBERTY ST
Practice Address - Street 2:SUITE R
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7804
Practice Address - Country:US
Practice Address - Phone:614-436-9070
Practice Address - Fax:614-436-8803
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC1945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0738102OtherMEDICARE PTAN
OHMO9354111Medicare ID - Type UnspecifiedMEDICARE
OH000000356855OtherANTHEM
OHU42071Medicare UPIN