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General NPI Number Information
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NPI Number | 1154627602
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Entity Type | Individual
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Provider Name | JORDAN D BOWEN D.C.
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Gender | Male
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Dates
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Enumeration Date | 02/01/2011
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Last Update Date | 04/21/2022
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Provider Practice Location Address
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Address Line | 357 S MAIN ST
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City | GREENVILLE
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State | PA
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Zip | 16125-1864
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Country | US
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Telephone | 724-854-8901
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Fax |
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Provider Business Mailing Address
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Address Line | 357 S MAIN ST
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City | GREENVILLE
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State | PA
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Zip | 16125-1864
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Country | US
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Telephone | 724-588-3128
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC010530
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License Number State | PA
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