Provider Demographics
NPI:1790848356
Name:BOWERS, TODD LEROY (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:LEROY
Last Name:BOWERS
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 1:1048 OGDEN AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2894
Mailing Address - Country:US
Mailing Address - Phone:630-322-9522
Mailing Address - Fax:630-322-9515
Practice Address - Street 1:1048 OGDEN AVE
Practice Address - Street 2:STE 110
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2894
Practice Address - Country:US
Practice Address - Phone:630-322-9522
Practice Address - Fax:630-322-9515
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-006662111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU39261Medicare UPIN
IL321190Medicare ID - Type Unspecified