Provider Demographics
NPI:1598824807
Name:DAWSON, GREGORY A (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:DAWSON
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:P.O. BOX 50
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:61529
Mailing Address - Country:US
Mailing Address - Phone:309-742-8921
Mailing Address - Fax:309-742-8921
Practice Address - Street 1:116 N. MAGNOLIA UNIT C
Practice Address - Street 2:
Practice Address - City:ELMWOOD
Practice Address - State:IL
Practice Address - Zip Code:61529
Practice Address - Country:US
Practice Address - Phone:309-742-8921
Practice Address - Fax:309-742-8921
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009223111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL07232030OtherBC BS PROVIDER
ILU84044Medicare UPIN