Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 13142 | TX |
Y | 111NS0005X | Chiropractic Sports Physician | 13142 | TX |
NPI | 1144741075 |
---|---|
Provider Name | Tyler Scott Bowman |
First Address | Dickinson, TX 77539-5597 |
Second Address | Dickinson, TX 77539-5597 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2017 |
Last Update Date | 17/03/2018 |