Healthcare Provider Details

I. General information

NPI: 1073636486
Provider Name (Legal Business Name): LOWERY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ST SE STE A
TUMWATER WA
98501-5200
US

IV. Provider business mailing address

200 W ST SE STE A
TUMWATER WA
98501-5200
US

V. Phone/Fax

Practice location:
  • Phone: 360-786-8600
  • Fax:
Mailing address:
  • Phone: 360-786-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH00033886
License Number StateWA

VIII. Authorized Official

Name: DR. SUSAN LOWERY
Title or Position: OWNER
Credential: D.C.
Phone: 360-786-8600