Provider Demographics
NPI:1508947359
Name:BOWARS, CRAIG A (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
Last Name:BOWARS
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 1:1415 CROXTON AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-7057
Mailing Address - Country:US
Mailing Address - Phone:309-829-3330
Mailing Address - Fax:
Practice Address - Street 1:1415 CROXTON AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-7057
Practice Address - Country:US
Practice Address - Phone:309-829-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL555520Medicare PIN