Provider Demographics
NPI:1861599862
Name:BOWIE, KEVIN R
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:R
Last Name:BOWIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 S NEIL ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7504
Mailing Address - Country:US
Mailing Address - Phone:217-359-7702
Mailing Address - Fax:217-359-7702
Practice Address - Street 1:2106 S NEIL ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7504
Practice Address - Country:US
Practice Address - Phone:217-359-7702
Practice Address - Fax:217-359-7702
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01032012OtherBCBS PROVIDER NUMBER
IL204477Medicare ID - Type Unspecified