Healthcare Provider Details

I. General information

NPI: 1093475709
Provider Name (Legal Business Name): COWELL CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 N FORTUNA BLVD
FORTUNA CA
95540-2724
US

IV. Provider business mailing address

431 N FORTUNA BLVD
FORTUNA CA
95540-2724
US

V. Phone/Fax

Practice location:
  • Phone: 707-726-9179
  • Fax: 707-726-9185
Mailing address:
  • Phone: 707-726-9179
  • Fax: 707-726-9185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MRS. JACQUITA M TERRELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 707-923-2880