=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134412968
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASHLEY R FOWLER DC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2011
-----------------------------------------------------
Last Update Date | 06/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1570 S CANFIELD NILES RD BUILDING A SUITE 103
-----------------------------------------------------
City | AUSTINTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44515-4042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-793-4445
-----------------------------------------------------
Fax | 330-793-1990
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1570 S CANFIELD NILES RD BUILDING A SUITE 103
-----------------------------------------------------
City | AUSTINTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44515-4042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-793-4445
-----------------------------------------------------
Fax | 330-793-1990
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE OWNER
-----------------------------------------------------
Name | DR. ASHLEY R FOWLER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 330-793-4445
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3960
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------