Provider Demographics
NPI:1104929769
Name:NOWMAN, RONALD GEORGE (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GEORGE
Last Name:NOWMAN
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 1:300 N KENNEDY DRIVE
Mailing Address - Street 2:2
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915
Mailing Address - Country:US
Mailing Address - Phone:815-933-6624
Mailing Address - Fax:815-933-6664
Practice Address - Street 1:300 N KENNEDY DRIVE
Practice Address - Street 2:2
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915
Practice Address - Country:US
Practice Address - Phone:815-933-6624
Practice Address - Fax:815-933-6664
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
270160Medicare UPIN
IL270160Medicare ID - Type Unspecified