Healthcare Provider Details

I. General information

NPI: 1538314729
Provider Name (Legal Business Name): TERRY KEVIN KOWALKE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 HENNEPIN AVE STE. 311
MINNEAPOLIS MN
55408-1002
US

IV. Provider business mailing address

6423 COLONY WAY #2D
EDINA MN
55435-2259
US

V. Phone/Fax

Practice location:
  • Phone: 612-284-4535
  • Fax:
Mailing address:
  • Phone: 952-956-2305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5136
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: