Healthcare Provider Details

I. General information

NPI: 1831167774
Provider Name (Legal Business Name): KRISTINA MILIK KOWALSKI D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTINA ANGELA MILIK

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 ALLEN ST
HAMPDEN MA
01036-9552
US

IV. Provider business mailing address

5 WANDERING MDWS
WILBRAHAM MA
01095-1364
US

V. Phone/Fax

Practice location:
  • Phone: 413-219-3109
  • Fax:
Mailing address:
  • Phone: 413-219-3109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3061
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: