Provider Demographics
NPI:1013957315
Name:ROWELL, BONNY F (DC)
Entity Type:Individual
Prefix:
First Name:BONNY
Middle Name:F
Last Name:ROWELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 VALLEY VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-6527
Mailing Address - Country:US
Mailing Address - Phone:814-941-1400
Mailing Address - Fax:814-941-0862
Practice Address - Street 1:1915 VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-6527
Practice Address - Country:US
Practice Address - Phone:814-941-1400
Practice Address - Fax:814-941-0862
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004195L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012294250003Medicaid
PA610388OtherHIGHMARK
PA0012294250003Medicaid
PA610388OtherHIGHMARK