Healthcare Provider Details

I. General information

NPI: 1952460313
Provider Name (Legal Business Name): JEFFRY DAVID BOWERS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24024 84TH AVE W
EDMONDS WA
98026-9152
US

IV. Provider business mailing address

12425 NE 155TH PL
WOODINVILLE WA
98072-7932
US

V. Phone/Fax

Practice location:
  • Phone: 425-776-4224
  • Fax: 425-672-8695
Mailing address:
  • Phone: 206-719-5229
  • Fax: 425-672-8695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number33755
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: