Provider Demographics
NPI:1780849455
Name:COWAN, BEVERLY K (DAOM, LAC)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:K
Last Name:COWAN
Suffix:
Gender:F
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8113 E FLORENTINE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-8461
Mailing Address - Country:US
Mailing Address - Phone:480-947-2535
Mailing Address - Fax:
Practice Address - Street 1:8113 E FLORENTINE RD
Practice Address - Street 2:SUITE A
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8461
Practice Address - Country:US
Practice Address - Phone:480-947-2535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0500171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist