Mary Lee Ann Fowler, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

9853 Issued in FL

Practice address

11512 Lake Mead Ave
Suite 203
Jacksonville, FL 32256-1400

Phone

(270) 210-9577

NPI assigned

Nov 11, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mary Lee Ann McConnell Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dilatush Chiropractic, Inc.

  • Chiropractor
  • Benton, KY
  • NPI 1225315203
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350518400000",
    "number": "1477707974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 PROFESSIONAL DR STE 105",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "320827228",
            "telephone_number": "270-210-9577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11512 LAKE MEAD AVE",
            "address_2": "SUITE 203",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322561400",
            "telephone_number": "270-210-9577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOWLER",
        "first_name": "MARY",
        "middle_name": "LEE ANN",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-11",
        "last_updated": "2012-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "9853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "MCCONNELL",
            "middle_name": "LEE ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mark Erik Foutz, CRNA
• Austin Richard Fowler, DMD
• Destiny Fowler
• Jantzen Sean Fowler, MD
• Kimberly Ann Fowler, LMT
• Nathanial James Fowler
• Sally A Fowler, LCSW
• Sydney Fowler, DMD
• Fox Mental Helath Services
• Cheryl Fox, LMT

• Chiropractor in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.