Healthcare Provider Details

I. General information

NPI: 1477707974
Provider Name (Legal Business Name): MARY LEE ANN FOWLER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY LEE ANN MCCONNELL

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5749 WESTGATE DR STE 103
ORLANDO FL
32835-5040
US

IV. Provider business mailing address

5749 WESTGATE DR STE 103
ORLANDO FL
32835-5040
US

V. Phone/Fax

Practice location:
  • Phone: 407-501-6743
  • Fax:
Mailing address:
  • Phone: 270-210-9577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9853
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: