Healthcare Provider Details

I. General information

NPI: 1740356922
Provider Name (Legal Business Name): MICHAEL ROBERT KOWALSKI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8006 SHEPHERDSVILLE RD
LOUISVILLE KY
40219-4050
US

IV. Provider business mailing address

8006 SHEPHERDSVILLE RD
LOUISVILLE KY
40219-4050
US

V. Phone/Fax

Practice location:
  • Phone: 502-964-9800
  • Fax: 502-964-1847
Mailing address:
  • Phone: 502-964-9800
  • Fax: 502-964-1847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4524
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: