Healthcare Provider Details

I. General information

NPI: 1457449928
Provider Name (Legal Business Name): JEFFREY ALAN KOWACHIK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6881 S HOLLY CIR STE 207
CENTENNIAL CO
80112-1145
US

IV. Provider business mailing address

6881 S HOLLY CIR STE 207
CENTENNIAL CO
80112-1145
US

V. Phone/Fax

Practice location:
  • Phone: 303-221-3600
  • Fax: 720-529-0222
Mailing address:
  • Phone: 303-221-3600
  • Fax: 720-529-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHR.0006915
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: