Provider Demographics
NPI:1023020336
Name:BOWERS, DEREK M (DC PLLC)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:M
Last Name:BOWERS
Suffix:
Gender:M
Credentials:DC PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13982 MERRIMAN RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-4259
Mailing Address - Country:US
Mailing Address - Phone:734-425-5454
Mailing Address - Fax:734-425-8779
Practice Address - Street 1:13982 MERRIMAN RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-4259
Practice Address - Country:US
Practice Address - Phone:734-425-5454
Practice Address - Fax:734-425-8779
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2019-10-10
Deactivation Date:2019-08-21
Deactivation Code:
Reactivation Date:2019-10-10
Provider Licenses
StateLicense IDTaxonomies
MIDB004839111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H22814OtherBCBSM
MIT33659Medicare UPIN