Provider Demographics
NPI:1043491301
Name:FOWLER CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:FOWLER CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:520-579-7906
Mailing Address - Street 1:8245 N SILVERBELL RD
Mailing Address - Street 2:SUITE 159
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-7381
Mailing Address - Country:US
Mailing Address - Phone:520-579-7906
Mailing Address - Fax:520-579-7912
Practice Address - Street 1:8245 N SILVERBELL RD
Practice Address - Street 2:SUITE 159
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-7381
Practice Address - Country:US
Practice Address - Phone:520-579-7906
Practice Address - Fax:520-579-7912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1063473858OtherTYPE 1
SC1043491301OtherTYPE 2