Provider Demographics
NPI:1245527480
Name:DAWSON CHIROPRACTIC P.C.
Entity type:Organization
Organization Name:DAWSON CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-742-8921
Mailing Address - Street 1:PO BOX 50
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:61529
Mailing Address - Country:US
Mailing Address - Phone:309-742-8921
Mailing Address - Fax:309-742-8921
Practice Address - Street 1:116 N MAGNOLIA
Practice Address - Street 2:UNIT C
Practice Address - City:ELMWOOD
Practice Address - State:IL
Practice Address - Zip Code:61529
Practice Address - Country:US
Practice Address - Phone:309-742-8921
Practice Address - Fax:309-742-8921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009223111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU84044Medicare UPIN