Provider Demographics
NPI:1669691358
Name:MCGOWAN CHIROPRACTIC CLINIC LTD.
Entity type:Organization
Organization Name:MCGOWAN CHIROPRACTIC CLINIC LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MCGOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-888-3131
Mailing Address - Street 1:750 FLETCHER DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4703
Mailing Address - Country:US
Mailing Address - Phone:847-888-3131
Mailing Address - Fax:847-888-3359
Practice Address - Street 1:750 FLETCHER DR
Practice Address - Street 2:SUITE 304
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4703
Practice Address - Country:US
Practice Address - Phone:847-888-3131
Practice Address - Fax:847-888-3359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-004108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532111OtherMEDICARE
IL04532111OtherBCBS
IL04532111OtherMEDICARE