Provider Demographics
NPI:1902967102
Name:BOWLES, JAMES PHILIP (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PHILIP
Last Name:BOWLES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:J
Other - Middle Name:PHILIP
Other - Last Name:BOWLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 499
Mailing Address - Street 2:
Mailing Address - City:MT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047
Mailing Address - Country:US
Mailing Address - Phone:502-538-4225
Mailing Address - Fax:502-538-6776
Practice Address - Street 1:184 N BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:MT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047
Practice Address - Country:US
Practice Address - Phone:502-538-4225
Practice Address - Fax:502-538-6776
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4318111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000186603OtherANTHEM
KY6464123456002Medicaid
KY10802437OtherCAQH
KY10802437OtherCAQH
KY6091501Medicare ID - Type Unspecified