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General NPI Number Information
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NPI Number | 1962682856
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Entity Type | Organization
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Legal Business Name | BOWMAN CHIROPRACTIC P C
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 10/08/2013
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Provider Practice Location Address
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Address Line | 202 S BROADWAY AVE
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City | SALEM
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State | IL
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Zip | 62881-1612
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Country | US
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Telephone | 618-548-5252
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Fax | 618-548-5261
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Provider Business Mailing Address
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Address Line | 202 S BROADWAY AVE
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City | SALEM
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State | IL
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Zip | 62881-1612
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Country | US
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Telephone | 618-548-5252
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Fax | 618-548-5261
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL R BOWMAN
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Credential | DC
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Telephone | 618-548-5252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 038-006573
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License Number State | IL
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