Provider Demographics
NPI:1790733723
Name:BOWMAN, JOHN K (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:BOWMAN
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 1:311 MAPLE AVE WEST
Mailing Address - Street 2:SUITE F
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4309
Mailing Address - Country:US
Mailing Address - Phone:703-281-2844
Mailing Address - Fax:703-281-4967
Practice Address - Street 1:311 MAPLE AVE W
Practice Address - Street 2:SUITE F
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4309
Practice Address - Country:US
Practice Address - Phone:703-281-2844
Practice Address - Fax:703-281-4967
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000129111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA408614Medicare PIN