Healthcare Provider Details

I. General information

NPI: 1972536829
Provider Name (Legal Business Name): BOWEN FAMILY CHIROPRACTIC CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N AIRPORT RD
JASPER AL
35504-7533
US

IV. Provider business mailing address

405 N AIRPORT RD
JASPER AL
35504-7533
US

V. Phone/Fax

Practice location:
  • Phone: 205-221-3196
  • Fax: 205-221-3101
Mailing address:
  • Phone: 205-221-3196
  • Fax: 205-221-3101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1073
License Number StateAL

VIII. Authorized Official

Name: MRS. C RENEE PHILPOT-BOWEN
Title or Position: OWNER/
Credential: D.C.
Phone: 205-221-3196