Provider Demographics
NPI:1700082278
Name:BOWSER, LAWRENCE GRANT JR (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:GRANT
Last Name:BOWSER
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 GREENMOOR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-7511
Mailing Address - Country:US
Mailing Address - Phone:949-857-1706
Mailing Address - Fax:
Practice Address - Street 1:30111 NIGUEL RD STE D
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2260
Practice Address - Country:US
Practice Address - Phone:949-495-9884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23750111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor