MEDICARE: DR. SALLY JANE STOWERS D.C.

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	111N00000X	Chiropractor	21816	CA
2	225200000X	Physical Therapy Assistant	2052	CA

General Provider Information

NPI Number	:	1164778254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALLY JANE STOWERS D.C.

Provider Business Mailing Address
First Line	:	1848 N MICHIGAN AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-1452
Country	:	US
Telephone Number	:	626-791-4570
Fax Number	:

Provider Business Practice Location Address
First Line	:	1848 N MICHIGAN AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-1452
Country	:	US
Telephone Number	:	626-791-4570
Fax Number	:

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

Provider Enumeration Date	:	07/26/2012
Last Update Date	:	07/26/2012

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