Provider Demographics
NPI:1487879219
Name:BOWLER, BRIGETTE (DC)
Entity type:Individual
Prefix:
First Name:BRIGETTE
Middle Name:
Last Name:BOWLER
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 1:23158 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1341
Mailing Address - Country:US
Mailing Address - Phone:248-547-5093
Mailing Address - Fax:248-547-1829
Practice Address - Street 1:23158 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1341
Practice Address - Country:US
Practice Address - Phone:248-547-5093
Practice Address - Fax:248-547-1829
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBB006851111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F35232OtherBCBSM PIN
MI0F35232OtherBCBSM PIN
MI0F35232Medicare ID - Type Unspecified