Provider Demographics
NPI:1700881216
Name:BOWERS, KYLE S (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:S
Last Name:BOWERS
Suffix:
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 1:3906 PEACHTREE DR
Mailing Address - Street 2:STE D
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4925
Mailing Address - Country:US
Mailing Address - Phone:573-256-6506
Mailing Address - Fax:573-256-6508
Practice Address - Street 1:3906 PEACHTREE DR
Practice Address - Street 2:STE D
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4925
Practice Address - Country:US
Practice Address - Phone:573-256-6506
Practice Address - Fax:573-256-6508
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004018277111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO193262OtherBLUE CROSS BLUE SHIELD
MO242298OtherGHP PIN
MO682555OtherHEALTHLINK
MO193262OtherBLUE CROSS BLUE SHIELD
MO000014474Medicare PIN