MEDICARE: DR. RYAN N BOWLIN 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	1450	NE

General Provider Information

NPI Number	:	1700931326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN N BOWLIN D.C.

Provider Business Mailing Address
First Line	:	1463 19TH AVE
Second Line	:
City	:	MITCHELL
State	:	NE
Zip	:	69357-1455
Country	:	US
Telephone Number	:	308-623-1313
Fax Number	:	308-623-1315

Provider Business Practice Location Address
First Line	:	1463 19TH AVE
Second Line	:
City	:	MITCHELL
State	:	NE
Zip	:	69357-1455
Country	:	US
Telephone Number	:	308-623-1313
Fax Number	:	308-623-1315

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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