MEDICARE: DR. OTSIC CLARK STOWELL III DC

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	1950	CO

General Provider Information

NPI Number	:	1750497152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OTSIC CLARK STOWELL III DC

Provider Business Mailing Address
First Line	:	1120 ALPINE AVE
Second Line	:	SUITE E
City	:	BOULDER
State	:	CO
Zip	:	80304-3414
Country	:	US
Telephone Number	:	303-442-7900
Fax Number	:	303-442-7995

Provider Business Practice Location Address
First Line	:	1120 ALPINE AVE
Second Line	:	SUITE E
City	:	BOULDER
State	:	CO
Zip	:	80304-3414
Country	:	US
Telephone Number	:	303-442-7900
Fax Number	:	303-442-7995

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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