Provider Demographics
NPI:1275009896
Name:BOWKER, NATHAN D
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:D
Last Name:BOWKER
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 1:7005 SHANNON WILLOW RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-1303
Mailing Address - Country:US
Mailing Address - Phone:704-541-6400
Mailing Address - Fax:704-541-4169
Practice Address - Street 1:7005 SHANNON WILLOW RD STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-1303
Practice Address - Country:US
Practice Address - Phone:704-541-6400
Practice Address - Fax:704-541-4169
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor