MEDICARE: DR. KEITH BOWEN GOVER 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	2301006620	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OF32538	OTHER	MI	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1700087939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH BOWEN GOVER D.C.

Provider Business Mailing Address
First Line	:	28051 DEQUINDRE RD STE F
Second Line	:
City	:	MADISON HTS
State	:	MI
Zip	:	48071-3016
Country	:	US
Telephone Number	:	248-733-5442
Fax Number	:	248-963-6214

Provider Business Practice Location Address
First Line	:	28051 DEQUINDRE RD STE F
Second Line	:
City	:	MADISON HTS
State	:	MI
Zip	:	48071-3016
Country	:	US
Telephone Number	:	248-733-5442
Fax Number	:	248-963-6214

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

Provider Enumeration Date	:	05/28/2007
Last Update Date	:	06/20/2022

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