Provider Demographics
NPI:1184795304
Name:BOWLBY, DAREN D (DC)
Entity type:Individual
Prefix:
First Name:DAREN
Middle Name:D
Last Name:BOWLBY
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 1:1157 3RD AVE
Mailing Address - Street 2:SUITE 145
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-6000
Mailing Address - Country:US
Mailing Address - Phone:360-575-8897
Mailing Address - Fax:360-575-8898
Practice Address - Street 1:1157 3RD AVE
Practice Address - Street 2:SUITE 145
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-6000
Practice Address - Country:US
Practice Address - Phone:360-575-8897
Practice Address - Fax:360-575-8898
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA120410OtherLABOR AND INDUSTRIES PROV
WABO8569OtherREGENCE RIDER NO
WA8854732Medicare PIN
U68308Medicare UPIN
WABO8569OtherREGENCE RIDER NO