Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC001839L | PA |
NPI | 1235109406 |
---|---|
Provider Name | Dr. Daniel S. Bowerman |
First Address | Philadelphia, PA 19147-1507 |
Second Address | Philadelphia, PA 19147-1507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000614 | HIGHMARK BLUE SHIELD (01) | PA |
0060992000 | IBC PERSONAL CHOICE (01) | PA |
0060992000 | KHPE HMO (01) | PA |
2633236 | AETNA (01) | PA |
J000614 | AMERIHEALTH ADMINISTRATOR (01) | PA |