Healthcare Provider Details

I. General information

NPI: 1962702944
Provider Name (Legal Business Name): GARY S. LOWE, D.C. A CHIROPRACTIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 N SHERMAN AVE
MANTECA CA
95336-4716
US

IV. Provider business mailing address

243 N SHERMAN AVE
MANTECA CA
95336-4716
US

V. Phone/Fax

Practice location:
  • Phone: 209-239-1999
  • Fax: 209-239-3077
Mailing address:
  • Phone: 209-239-1999
  • Fax: 209-239-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number15295
License Number StateCA

VIII. Authorized Official

Name: DR. GARY S LOWE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 209-239-1999