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General NPI Number Information
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NPI Number | 1285806133
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Entity Type | Organization
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Legal Business Name | FOWLER CHIROPRACTIC PC
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 01/06/2012
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Provider Practice Location Address
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Address Line | 335 N 120TH AVE
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City | HOLLAND
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State | MI
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Zip | 49424-2118
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Country | US
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Telephone | 616-392-3363
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Fax | 616-392-9030
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Provider Business Mailing Address
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Address Line | 335 N 120TH AVE
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City | HOLLAND
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State | MI
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Zip | 49424-2118
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Country | US
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Telephone | 616-392-3363
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Fax | 616-392-9030
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. REBECCA OTT
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Credential |
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Telephone | 616-392-3363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | TF005434
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License Number State | MI
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