Healthcare Provider Details

I. General information

NPI: 1831157676
Provider Name (Legal Business Name): ANGELA CHRISTINE KOWALCZYK D.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W GUADALUPE RD STE 301
GILBERT AZ
85233-3333
US

IV. Provider business mailing address

201 W GUADALUPE RD STE 301
GILBERT AZ
85233-3333
US

V. Phone/Fax

Practice location:
  • Phone: 480-892-7500
  • Fax: 480-892-7501
Mailing address:
  • Phone: 480-892-7500
  • Fax: 480-892-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7489
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: