Provider Demographics
NPI:1649316134
Name:BOWEN, LAURA KRISTINE (DC)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:KRISTINE
Last Name:BOWEN
Suffix:
Gender:F
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:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-0027
Mailing Address - Country:US
Mailing Address - Phone:631-647-8324
Mailing Address - Fax:631-647-8324
Practice Address - Street 1:99 E MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2538
Practice Address - Country:US
Practice Address - Phone:631-647-8324
Practice Address - Fax:516-352-0051
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010865111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC10865-6BOtherWORKER'S COMPENSATION
NY3605533OtherACN
NYC10865-6BOtherWORKER'S COMPENSATION
NY3605533OtherACN