Provider Demographics
NPI:1992995070
Name:FOWLER, JASON CLEO (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:CLEO
Last Name:FOWLER
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 1:2057 WILSON CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60503-3610
Mailing Address - Country:US
Mailing Address - Phone:314-578-9022
Mailing Address - Fax:
Practice Address - Street 1:525 S SCHMALE RD
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2451
Practice Address - Country:US
Practice Address - Phone:331-871-2039
Practice Address - Fax:630-324-4965
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010938111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000000570383OtherANTHEM BCBS
MOP00655474OtherRR MEDICARE
IL217108002Medicare PIN
MOMA1173001Medicare PIN