Provider Demographics
NPI:1144333931
Name:FOWLER, JEFFREY ADAM (DC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ADAM
Last Name:FOWLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4819
Mailing Address - Country:US
Mailing Address - Phone:352-344-1300
Mailing Address - Fax:352-341-4500
Practice Address - Street 1:108 W HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4819
Practice Address - Country:US
Practice Address - Phone:352-344-1300
Practice Address - Fax:352-341-4500
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8687111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor