Provider Demographics
NPI:1538273156
Name:LOWE, LONNIE DEAN (DC)
Entity type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:DEAN
Last Name:LOWE
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 1:3528 13TH AVE SW STE A
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512-5581
Mailing Address - Country:US
Mailing Address - Phone:360-951-0514
Mailing Address - Fax:
Practice Address - Street 1:3948 CLEVELAND AVE SE
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-4023
Practice Address - Country:US
Practice Address - Phone:360-570-9580
Practice Address - Fax:360-570-9583
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0023427OtherDEPT.L&I
WAG8856480Medicare ID - Type Unspecified