Provider Demographics
NPI:1356725600
Name:COWELL, BENJAMIN ROY (DC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ROY
Last Name:COWELL
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 1:441 MELVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GARBERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95542-3409
Mailing Address - Country:US
Mailing Address - Phone:707-923-2880
Mailing Address - Fax:707-923-2881
Practice Address - Street 1:441 MELVILLE RD
Practice Address - Street 2:
Practice Address - City:GARBERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95542-3409
Practice Address - Country:US
Practice Address - Phone:707-923-2880
Practice Address - Fax:707-923-2881
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor