Provider Demographics
NPI:1730342270
Name:GRECO-BOWMAN CHIROPRACTIC INC
Entity type:Organization
Organization Name:GRECO-BOWMAN CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BUCK
Authorized Official - Middle Name:ERICKSON
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-272-1800
Mailing Address - Street 1:790 W AVENUE Q
Mailing Address - Street 2:SUITE A
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3768
Mailing Address - Country:US
Mailing Address - Phone:661-272-1800
Mailing Address - Fax:661-272-9861
Practice Address - Street 1:790 W AVENUE Q
Practice Address - Street 2:SUITE A
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3768
Practice Address - Country:US
Practice Address - Phone:661-272-1800
Practice Address - Fax:661-272-9861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-04
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty