Healthcare Provider Details

I. General information

NPI: 1457513194
Provider Name (Legal Business Name): JAMES SHAWN MCCOWIN L.M.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 09/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 SE MAIN ST SUITE B
ROSEBURG OR
97470-3938
US

IV. Provider business mailing address

725 SE MAIN ST SUITE B
ROSEBURG OR
97470-3938
US

V. Phone/Fax

Practice location:
  • Phone: 888-280-7891
  • Fax:
Mailing address:
  • Phone: 888-280-7891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number13844
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: