Provider Demographics
NPI:1780955112
Name:COWAN CHIROPRACTIC AND REHABILITATION
Entity type:Organization
Organization Name:COWAN CHIROPRACTIC AND REHABILITATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:302-654-0404
Mailing Address - Street 1:536 GREENHILL AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-1851
Mailing Address - Country:US
Mailing Address - Phone:302-777-7406
Mailing Address - Fax:
Practice Address - Street 1:536 GREENHILL AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-1851
Practice Address - Country:US
Practice Address - Phone:302-654-7246
Practice Address - Fax:302-777-7406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0009894208VP0014X
DEF10000381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty