Wesley Aaron Bowman, D.C.
Individual provider Active NPI Chiropractor · Soda Springs, ID
NPI 1154521409 · NPPES record last updated Jul 24, 2007
Key facts
- NPI
- 1154521409
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- C1255 (ID)
- Practice address
- 300 W 2ND S
Soda Springs, ID 83276-1515 - Phone
- (208) 547-4151
- Fax
- (208) 547-4093
- NPI assigned
- Jul 24, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 2007
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
300 W 2ND
Soda Springs, ID 83276-1515
Phone (208) 547-4151
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110608000206 | ID | Practitioner - Chiropractic | 7911184502 | Practice locations: Soda Springs, ID |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C1255 | ID | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bowman Chiropractic | Chiropractor | Past | Accepting new patients |
| Bowman Chiropractic PLLC | Chiropractor | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | C1255 | ID | Yes |
Addresses
Primary practice location
300 W 2ND S
Soda Springs, ID 83276-1515
Mailing address
300 W 2ND S
Soda Springs, ID 83276-1515
Phone (208) 547-4151
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C1255 | Other | ID | STATE OF IDAHO LICENSE NU |
Other providers in Soda Springs, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.