Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 271566 | OR |
NPI | 1114009156 |
---|---|
Provider Name | Dr. Lee P Cowan |
First Address | Gresham, OR 97030 |
Second Address | Gresham, OR 97233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 28/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T67537 | (02) | OR |