Provider Demographics
NPI:1831212992
Name:DAVIS, NOEL COWART JR (DC)
Entity type:Individual
Prefix:DR
First Name:NOEL
Middle Name:COWART
Last Name:DAVIS
Suffix:JR
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 1:232 MAIN ST NW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1938
Mailing Address - Country:US
Mailing Address - Phone:815-939-4900
Mailing Address - Fax:815-939-4951
Practice Address - Street 1:232 MAIN ST NW
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1866
Practice Address - Country:US
Practice Address - Phone:815-939-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05844111N00000X
IL038-006330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002782002OtherBCBS
IL37-1243600OtherFED ID
IA0767558Medicaid
IA53643OtherBCBS WELLMARK
IA253414OtherMIDLANDS
IA9484203OtherPHCS
36-3862007OtherFEIN
ILT87441Medicare UPIN
IA0767558Medicaid
IL902930Medicare ID - Type Unspecified