Healthcare Provider Details

I. General information

NPI: 1245571454
Provider Name (Legal Business Name): KOWALSKI CHIROPRACTIC HEALTH & PERFORMANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 6TH AVE STE A
KEARNEY NE
68845-3393
US

IV. Provider business mailing address

4010 6TH AVE STE A
KEARNEY NE
68845-3393
US

V. Phone/Fax

Practice location:
  • Phone: 308-440-3686
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1743
License Number StateNE

VIII. Authorized Official

Name: TYLER KOWALSKI
Title or Position: OWNER
Credential: D.C.
Phone: 308-440-3686