Provider Demographics
NPI:1841207354
Name:MCDOWELL, BONNIE L (PT, DC)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:L
Last Name:MCDOWELL
Suffix:
Gender:F
Credentials:PT, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 MOUNTAIN VIEW LN STE 400
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2264
Mailing Address - Country:US
Mailing Address - Phone:503-357-2187
Mailing Address - Fax:503-357-2187
Practice Address - Street 1:1905 MOUNTAIN VIEW LN STE 400
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2264
Practice Address - Country:US
Practice Address - Phone:503-357-2187
Practice Address - Fax:503-357-2187
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1997111N00000X
OR0890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR033068001OtherBLUE CROSS FOR PT LICENSE
OR033068002OtherBLUE CROSS
ORR105913Medicare PIN