MEDICARE: DR. THOMAS J FOWLER DC, DACRB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301005434	MI

General Provider Information

NPI Number	:	1508831108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS J FOWLER DC, DACRB

Provider Business Mailing Address
First Line	:	335 N 120TH AVE
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49424-2118
Country	:	US
Telephone Number	:	616-392-3363
Fax Number	:	616-392-9030

Provider Business Practice Location Address
First Line	:	335 N 120TH AVE
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49424-2118
Country	:	US
Telephone Number	:	616-392-3363
Fax Number	:	616-392-9030

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	02/17/2022

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