Provider Demographics
NPI:1134239379
Name:GOWEN, DANA MICHELLE (DC)
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:MICHELLE
Last Name:GOWEN
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 1:2909 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-6272
Mailing Address - Country:US
Mailing Address - Phone:620-342-5663
Mailing Address - Fax:620-342-5663
Practice Address - Street 1:2909 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-6272
Practice Address - Country:US
Practice Address - Phone:620-342-5663
Practice Address - Fax:620-342-5663
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04614111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU66404Medicare UPIN
KS060933Medicare ID - Type UnspecifiedMEDICARE NUMBER