Healthcare Provider Details

I. General information

NPI: 1447904800
Provider Name (Legal Business Name): KATHRYN FOWLER DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 WILSHIRE BLVD STE 518
LOS ANGELES CA
90048-5223
US

IV. Provider business mailing address

420 SIERRA ST APT 8
EL SEGUNDO CA
90245-4077
US

V. Phone/Fax

Practice location:
  • Phone: 323-549-0070
  • Fax:
Mailing address:
  • Phone: 480-459-8044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number36260
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number36260
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: