Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 32686 | CA |
NPI | 1073944096 |
---|---|
Provider Name | Dr. Cody Fowler |
First Address | Los Gatos, CA 95030-6037 |
Second Address | Los Gatos, CA 95030-6037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2013 |
Last Update Date | 01/12/2013 |