Healthcare Provider Details

I. General information

NPI: 1780955112
Provider Name (Legal Business Name): COWAN CHIROPRACTIC AND REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 GREENHILL AVE
WILMINGTON DE
19805-1851
US

IV. Provider business mailing address

536 GREENHILL AVE
WILMINGTON DE
19805-1851
US

V. Phone/Fax

Practice location:
  • Phone: 302-654-7246
  • Fax: 302-777-7406
Mailing address:
  • Phone: 302-777-7406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberF10000381
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberC1-0009894
License Number StateDE

VIII. Authorized Official

Name: DR. WILLIAM THOMAS COWAN III
Title or Position: OWNER
Credential: DC
Phone: 302-654-0404