Provider Demographics
NPI:1952460313
Name:BOWERS, JEFFRY DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFRY
Middle Name:DAVID
Last Name:BOWERS
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 1:12425 NE 155TH PL
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-7932
Mailing Address - Country:US
Mailing Address - Phone:206-719-5229
Mailing Address - Fax:425-672-8695
Practice Address - Street 1:24024 84TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-9152
Practice Address - Country:US
Practice Address - Phone:425-776-4224
Practice Address - Fax:425-672-8695
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA33755111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG AB36719Medicare ID - Type Unspecified