1649316134 NPI number — DR. LAURA KRISTINE BOWEN D.C.

Table of content: DR. LAURA KRISTINE BOWEN D.C. (NPI 1649316134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649316134 NPI number — DR. LAURA KRISTINE BOWEN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWEN
Provider First Name:
LAURA
Provider Middle Name:
KRISTINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649316134
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ISLIP
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11751-0027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-647-8324
Provider Business Mailing Address Fax Number:
631-647-8324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
EAST ISLIP
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11730-2538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-647-8324
Provider Business Practice Location Address Fax Number:
516-352-0051
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  X010865 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C10865-6B . This is a "WORKER'S COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3605533 . This is a "ACN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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