Healthcare Provider Details

I. General information

NPI: 1053445643
Provider Name (Legal Business Name): JANICE SYLVIA KOWALSKI DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MAREBLU SUITE 230
ALISO VIEJO CA
92656-3044
US

IV. Provider business mailing address

11 MAREBLU SUITE 230
ALISO VIEJO CA
92656-3044
US

V. Phone/Fax

Practice location:
  • Phone: 949-643-5030
  • Fax: 949-643-5209
Mailing address:
  • Phone: 949-643-5030
  • Fax: 949-643-5209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC15978
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT8944
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: