MEDICARE: DR. JEREMY A BOWMAN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	2556	SC
2	111N00000X	Chiropractor	4402	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4402	OTHER	SC	SOUTH CAROLINA DEPT. OF LABOR, LICENSING AND REGULATION

General Provider Information

NPI Number	:	1134681877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY A BOWMAN DC

Provider Business Mailing Address
First Line	:	365A E BLACKSTOCK RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29301-3762
Country	:	US
Telephone Number	:	864-574-4862
Fax Number	:	864-587-6858

Provider Business Practice Location Address
First Line	:	365A E BLACKSTOCK RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29301-3762
Country	:	US
Telephone Number	:	864-574-4862
Fax Number	:	864-587-6858

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2019
Last Update Date	:	12/17/2019

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