Healthcare Provider Details

I. General information

NPI: 1700975695
Provider Name (Legal Business Name): ALLEN W KOWARSKI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3970 WALNUT ST
FAIRFAX VA
22030
US

IV. Provider business mailing address

3970 WALNUT ST
FAIRFAX VA
22030
US

V. Phone/Fax

Practice location:
  • Phone: 703-291-6677
  • Fax: 703-649-6411
Mailing address:
  • Phone: 703-291-6677
  • Fax: 703-649-6411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104000650
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: