Provider Demographics
NPI:1447904800
Name:FOWLER, KATHRYN (DC)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:FOWLER
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 1:420 SIERRA ST APT 8
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4077
Mailing Address - Country:US
Mailing Address - Phone:480-459-8044
Mailing Address - Fax:
Practice Address - Street 1:6221 WILSHIRE BLVD STE 518
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5223
Practice Address - Country:US
Practice Address - Phone:323-549-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36260111NP0017X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor