MEDICARE: DR. TODD LEROY BOWERS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	038-006662	IL

General Provider Information

NPI Number	:	1790848356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD LEROY BOWERS D.C.

Provider Business Mailing Address
First Line	:	1048 OGDEN AVE
Second Line	:	STE 110
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-2894
Country	:	US
Telephone Number	:	630-322-9522
Fax Number	:	630-322-9515

Provider Business Practice Location Address
First Line	:	1048 OGDEN AVE
Second Line	:	STE 110
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-2894
Country	:	US
Telephone Number	:	630-322-9522
Fax Number	:	630-322-9515

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	07/08/2007

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