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General NPI Number Information
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NPI Number | 1831212992
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Entity Type | Individual
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Provider Name | NOEL COWART DAVIS JR. D.C.
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Gender | Male
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 05/15/2014
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Provider Practice Location Address
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Address Line | 232 MAIN ST NW
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City | BOURBONNAIS
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State | IL
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Zip | 60914-1866
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Country | US
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Telephone | 815-939-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 232 MAIN ST NW SUITE 201
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City | BOURBONNAIS
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State | IL
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Zip | 60914-1938
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Country | US
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Telephone | 815-939-4900
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Fax | 815-939-4951
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | A05844
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038-006330
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License Number State | IL
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