Provider Demographics
NPI:1871678383
Name:PROWELL, DENNIS A (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:A
Last Name:PROWELL
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 1:12015 S. WESTERN AVE.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406
Mailing Address - Country:US
Mailing Address - Phone:708-371-9347
Mailing Address - Fax:708-371-9359
Practice Address - Street 1:12015 S. WESTERN AVE.
Practice Address - Street 2:SUITE 202
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406
Practice Address - Country:US
Practice Address - Phone:708-371-9347
Practice Address - Fax:708-371-9359
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor