Healthcare Provider Details

I. General information

NPI: 1790721058
Provider Name (Legal Business Name): COWAN CHIROPRACTIC & REHABILITATION, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 GREENHILL AVE
WILMINGTON DE
19805-1851
US

IV. Provider business mailing address

705 S CLAYTON ST
WILMINGTON DE
19805-4214
US

V. Phone/Fax

Practice location:
  • Phone: 302-654-0404
  • Fax:
Mailing address:
  • Phone: 302-655-9858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberF10000381
License Number StateDE

VIII. Authorized Official

Name: DR. WILLIAM THOMAS COWAN III
Title or Position: PRESIDENT
Credential: D.C.
Phone: 302-654-0404