Provider Demographics
NPI:1700064136
Name:BOWEN, ROBERT EARL (DC,)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EARL
Last Name:BOWEN
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 1:237 BARNWELL AVE NW
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-3903
Mailing Address - Country:US
Mailing Address - Phone:803-642-5707
Mailing Address - Fax:
Practice Address - Street 1:237 BARNWELL AVE NW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3903
Practice Address - Country:US
Practice Address - Phone:803-642-5707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1011111N00000X
SC630111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC630OtherLICENSEE
AZ1011OtherLICSENCE
AZAZ0235340OtherBCBS
AZAZ0235340OtherBCBS
AZT81960Medicare UPIN