Healthcare Provider Details

I. General information

NPI: 1225061112
Provider Name (Legal Business Name): DAVID ANDREW FOWLER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13028 INTERURBAN AVE S SUITE 106
TUKWILA WA
98168-3340
US

IV. Provider business mailing address

13028 INTERURBAN AVE S SUITE 106
TUKWILA WA
98168-3340
US

V. Phone/Fax

Practice location:
  • Phone: 206-957-7950
  • Fax: 206-957-7952
Mailing address:
  • Phone: 206-957-7950
  • Fax: 206-957-7952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberDC27430
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: