Healthcare Provider Details

I. General information

NPI: 1770576738
Provider Name (Legal Business Name): RENATA ANNA KOWAL DC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 DENBIGH BLVD SUITE 4
NEWPORT NEWS VA
23608-4485
US

IV. Provider business mailing address

640 DENBIGH BLVD SUITE 4
NEWPORT NEWS VA
23608-4485
US

V. Phone/Fax

Practice location:
  • Phone: 586-899-7256
  • Fax: 586-774-9583
Mailing address:
  • Phone: 586-899-7256
  • Fax: 586-774-9583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556353
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301008778
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: