Healthcare Provider Details

I. General information

NPI: 1235109406
Provider Name (Legal Business Name): DANIEL S. BOWERMAN D.C., F.A.C.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 S 4TH ST
PHILADELPHIA PA
19147-1507
US

IV. Provider business mailing address

512 S 4TH ST
PHILADELPHIA PA
19147-1507
US

V. Phone/Fax

Practice location:
  • Phone: 215-923-5577
  • Fax: 215-627-3530
Mailing address:
  • Phone: 215-923-5577
  • Fax: 215-627-3530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberDC001839L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: