Provider Demographics
NPI:1821201070
Name:COWAN, DARYL V (DC)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:V
Last Name:COWAN
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 1:1 PLAZA DR
Mailing Address - Street 2:SUITE 20
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-8823
Mailing Address - Country:US
Mailing Address - Phone:765-778-7399
Mailing Address - Fax:765-778-7399
Practice Address - Street 1:1 PLAZA DR
Practice Address - Street 2:SUITE 20
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-8823
Practice Address - Country:US
Practice Address - Phone:765-778-7399
Practice Address - Fax:765-778-7399
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200167160A21Medicaid
IN000000214574OtherBLUE NUMBER BCBS
IN351925531OtherFEDERAL TAX ID#
IN351925531OtherFEDERAL TAX ID#
IN509190Medicare ID - Type Unspecified