Healthcare Provider Details

I. General information

NPI: 1396170569
Provider Name (Legal Business Name): LOWRY CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8825 PERIMETER PARK BLVD STE 102
JACKSONVILLE FL
32216-1127
US

IV. Provider business mailing address

8825 PERIMETER PARK BLVD STE 102
JACKSONVILLE FL
32216-1127
US

V. Phone/Fax

Practice location:
  • Phone: 904-497-0823
  • Fax: 904-524-8379
Mailing address:
  • Phone: 904-497-0823
  • Fax: 386-310-8770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH10971
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberCH 10971
License Number StateFL

VIII. Authorized Official

Name: DR. MATTHEW DAVID LOWRY
Title or Position: OWNER
Credential: D.C.
Phone: 620-222-8616