=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992995070
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASON CLEO FOWLER D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2007
-----------------------------------------------------
Last Update Date | 06/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 525 S SCHMALE RD
-----------------------------------------------------
City | CAROL STREAM
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60188-2451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 331-871-2039
-----------------------------------------------------
Fax | 630-324-4965
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2057 WILSON CREEK CIR
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60503-3610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-578-9022
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038-010938
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------