Healthcare Provider Details

I. General information

NPI: 1457272288
Provider Name (Legal Business Name): BOWEN BEYKIRCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 S MARIO CAPECCHI DR
SALT LAKE CITY UT
84112-5888
US

IV. Provider business mailing address

1225 N MURRAY LN
LIBERTY LAKE WA
99019-7555
US

V. Phone/Fax

Practice location:
  • Phone: 509-570-3325
  • Fax:
Mailing address:
  • Phone: 509-570-3325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: