Provider Demographics
NPI:1245370048
Name:BOWN, GREGORY LARSON (DC,DIPLAC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LARSON
Last Name:BOWN
Suffix:
Gender:M
Credentials:DC,DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 S COUNTY FARM RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4526
Mailing Address - Country:US
Mailing Address - Phone:630-690-2080
Mailing Address - Fax:630-690-2174
Practice Address - Street 1:338 S COUNTY FARM RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4526
Practice Address - Country:US
Practice Address - Phone:630-690-2080
Practice Address - Fax:630-690-2174
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL399360Medicare ID - Type Unspecified