Healthcare Provider Details

I. General information

NPI: 1407166929
Provider Name (Legal Business Name): ROSS ALAN KOWZAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 RIDGEWAY AVE.
LOUISVILLE KY
40207
US

IV. Provider business mailing address

2514 HARMONY RD.
LOUISVILLE KY
40299
US

V. Phone/Fax

Practice location:
  • Phone: 502-618-0800
  • Fax:
Mailing address:
  • Phone: 618-318-3964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5256
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number5256
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5256
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: