Provider Demographics
NPI:1265202741
Name:SOWERSBY, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SOWERSBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 W FENN LN
Mailing Address - Street 2:
Mailing Address - City:SAINT DAVID
Mailing Address - State:AZ
Mailing Address - Zip Code:85630-6155
Mailing Address - Country:US
Mailing Address - Phone:520-270-4460
Mailing Address - Fax:
Practice Address - Street 1:730 W 4TH ST
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-6435
Practice Address - Country:US
Practice Address - Phone:520-270-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-010029171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist