Healthcare Provider Details

I. General information

NPI: 1013934009
Provider Name (Legal Business Name): SAMUEL KENT BOWMAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 N 1ST AVE
HOLBROOK AZ
86025-2803
US

IV. Provider business mailing address

307 N 1ST AVE
HOLBROOK AZ
86025-2803
US

V. Phone/Fax

Practice location:
  • Phone: 928-524-6855
  • Fax: 928-524-6856
Mailing address:
  • Phone: 928-524-6855
  • Fax: 928-524-6856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number822
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: