Provider Demographics
NPI:1912413691
Name:MCGOWAN, KATHLEEN (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:MCGOWAN
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:PO BOX 2024
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-2024
Mailing Address - Country:US
Mailing Address - Phone:208-630-6282
Mailing Address - Fax:208-630-6281
Practice Address - Street 1:106 E PARK ST STE 101
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-5064
Practice Address - Country:US
Practice Address - Phone:208-630-6282
Practice Address - Fax:208-630-6281
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60806853111N00000X
IDCHIA-2059111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor