Provider Demographics
NPI:1689660052
Name:FOWLER, STEPHEN MARTIN (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MARTIN
Last Name:FOWLER
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 1:6 WAY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06455-1080
Mailing Address - Country:US
Mailing Address - Phone:860-349-7034
Mailing Address - Fax:860-349-7093
Practice Address - Street 1:6 WAY RD
Practice Address - Street 2:
Practice Address - City:MIDDLEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06455-1080
Practice Address - Country:US
Practice Address - Phone:860-349-7034
Practice Address - Fax:860-349-7093
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001118111N00000X, 111NN1001X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NN1001XChiropractic ProvidersChiropractorNutrition
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050001118CT01OtherBLUE SHIELD ID
CTU53923Medicare UPIN