Provider Demographics
NPI:1831132307
Name:PHILPOT-BOWEN, C RENEE (DC)
Entity type:Individual
Prefix:
First Name:C
Middle Name:RENEE
Last Name:PHILPOT-BOWEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35504-7533
Mailing Address - Country:US
Mailing Address - Phone:205-221-3196
Mailing Address - Fax:205-221-3101
Practice Address - Street 1:405 N AIRPORT RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35504-7533
Practice Address - Country:US
Practice Address - Phone:205-221-3196
Practice Address - Fax:205-221-3101
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1073111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT68533Medicare UPIN
AL000070926Medicare ID - Type Unspecified