Healthcare Provider Details

I. General information

NPI: 1952411449
Provider Name (Legal Business Name): DONALD ERVIN OWENS JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E MAIN ST
DANVILLE IL
61832-5100
US

IV. Provider business mailing address

703 NOTTINGHAM DR
SAINT JOSEPH IL
61873-8927
US

V. Phone/Fax

Practice location:
  • Phone: 217-554-5238
  • Fax:
Mailing address:
  • Phone: 217-469-2375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209017761
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-007225
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: