Provider Demographics
NPI:1942360797
Name:BOWEN, BRANDON WADE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:WADE
Last Name:BOWEN
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:PO BOX 9066
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75608-9066
Mailing Address - Country:US
Mailing Address - Phone:903-663-5885
Mailing Address - Fax:903-663-0908
Practice Address - Street 1:3392 HIGHWAY 259 NORTH
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605
Practice Address - Country:US
Practice Address - Phone:903-663-5885
Practice Address - Fax:903-663-0908
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6817111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089078201Medicaid
TX89860BMedicare ID - Type Unspecified
TX089078201Medicaid