Provider Demographics
NPI:1023095825
Name:TOWNE, CORNELIUS AMOS
Entity type:Individual
Prefix:DR
First Name:CORNELIUS
Middle Name:AMOS
Last Name:TOWNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NEIL
Other - Middle Name:AMOS
Other - Last Name:TOWNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:3900 HILLCREST RD.
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9453
Mailing Address - Country:US
Mailing Address - Phone:541-779-8331
Mailing Address - Fax:
Practice Address - Street 1:977 ROYAL AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6140
Practice Address - Country:US
Practice Address - Phone:541-779-8331
Practice Address - Fax:541-779-0217
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR271290111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT92910Medicare UPIN