Provider Demographics
NPI:1114110517
Name:MCDOWELL CHIROPRACTIC CLINIC, S.C.
Entity Type:Organization
Organization Name:MCDOWELL CHIROPRACTIC CLINIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MCDOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-430-8372
Mailing Address - Street 1:P.O. BOX 280
Mailing Address - Street 2:
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514
Mailing Address - Country:US
Mailing Address - Phone:630-430-8372
Mailing Address - Fax:
Practice Address - Street 1:240 EAST OGDEN AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521
Practice Address - Country:US
Practice Address - Phone:630-430-8372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008640111N00000X
IL038.008640111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02223248OtherBLUE CROSS BLUE SHIELD IL
ILU74689Medicare UPIN
IL02223248OtherBLUE CROSS BLUE SHIELD IL