Provider Demographics
NPI:1700099868
Name:DR. DAVID F. BOWERS P.C.
Entity Type:Organization
Organization Name:DR. DAVID F. BOWERS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:FLOYD
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:815-675-9090
Mailing Address - Street 1:PO BOX 678
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60081-0678
Mailing Address - Country:US
Mailing Address - Phone:815-675-9090
Mailing Address - Fax:
Practice Address - Street 1:2100 N US HIGHWAY 12
Practice Address - Street 2:STE 201
Practice Address - City:SPRING GROVE
Practice Address - State:IL
Practice Address - Zip Code:60081-8308
Practice Address - Country:US
Practice Address - Phone:815-675-9090
Practice Address - Fax:815-207-7808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-04951261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01626083OtherBLUE CROSS BLUSHIELD
IL5615480001Medicare NSC
IL211621Medicare PIN