Provider Demographics
NPI:1366778201
Name:ADVANCED SPINAL REHABILITATION PC
Entity type:Organization
Organization Name:ADVANCED SPINAL REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-444-1230
Mailing Address - Street 1:938 UNIVERSITY PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-6283
Mailing Address - Country:US
Mailing Address - Phone:801-773-4130
Mailing Address - Fax:
Practice Address - Street 1:938 UNIVERSITY PARK BLVD
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-6283
Practice Address - Country:US
Practice Address - Phone:801-773-4130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty