Healthcare Provider Details

I. General information

NPI: 1174668438
Provider Name (Legal Business Name): MELISSA REA KOWASZ-MCKIM D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 E TERRA COTTA AVE STE 141
CRYSTAL LAKE IL
60014-3649
US

IV. Provider business mailing address

820 E TERRA COTTA AVE STE 141
CRYSTAL LAKE IL
60014-3649
US

V. Phone/Fax

Practice location:
  • Phone: 815-477-7718
  • Fax: 815-477-7121
Mailing address:
  • Phone: 815-477-7718
  • Fax: 815-477-7121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: