Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 3307 | FL |
NPI | 1073738951 |
---|---|
Provider Name | John Stanley Owens |
First Address | Bonifay, FL 32425-0325 |
Second Address | Bonifay, FL 32425-3112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T96757 | (02) | FL |