Provider Demographics
NPI:1629149794
Name:BOWLIN, GARY W (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:W
Last Name:BOWLIN
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 1:714 N VERMILION ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-3918
Mailing Address - Country:US
Mailing Address - Phone:217-446-7112
Mailing Address - Fax:217-446-5939
Practice Address - Street 1:714 N VERMILION ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3918
Practice Address - Country:US
Practice Address - Phone:217-446-7112
Practice Address - Fax:217-446-5939
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009395111N00000X
IL038-009395111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200558Medicare ID - Type Unspecified
ILU74776Medicare UPIN