Provider Demographics
NPI:1912109620
Name:LOWRY CHIROPRACTIC LIFE CENTER, PC
Entity Type:Organization
Organization Name:LOWRY CHIROPRACTIC LIFE CENTER, PC
Other - Org Name:GAYLORD CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-732-0665
Mailing Address - Street 1:702 N CENTER AVE
Mailing Address - Street 2:PO BOX 1305
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1508
Mailing Address - Country:US
Mailing Address - Phone:989-732-0665
Mailing Address - Fax:989-732-1429
Practice Address - Street 1:702 N CENTER AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1508
Practice Address - Country:US
Practice Address - Phone:989-732-0665
Practice Address - Fax:989-732-1429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDL007537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F950140OtherBLUECROSSBLUESHIELD #
MI950F950140OtherBLUECROSSBLUESHIELD #
MI0P01990001Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER