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General NPI Number Information
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NPI Number | 1205237559
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Entity Type | Organization
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Legal Business Name | BACK & NECK CARE CLINIC, LLC
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Dates
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Enumeration Date | 09/05/2014
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Last Update Date | 10/01/2015
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Provider Practice Location Address
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Address Line | 410 E MAIN ST
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City | MASCOUTAH
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State | IL
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Zip | 62258-2229
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Country | US
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Telephone | 618-566-3005
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Fax | 618-551-2777
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Provider Business Mailing Address
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Address Line | 410 E MAIN ST
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City | MASCOUTAH
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State | IL
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Zip | 62258-2229
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Country | US
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Telephone | 618-566-3005
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Fax | 618-551-2777
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID BOWDEN II
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Credential | D.C.
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Telephone | 618-566-3005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 038012578
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License Number State | IL
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