Healthcare Provider Details

I. General information

NPI: 1245813658
Provider Name (Legal Business Name): LOWELL THOMAS KOVACICH DC, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date: 07/15/2024
Reactivation Date: 07/31/2024

III. Provider practice location address

902 S SULLIVAN RD
SPOKANE VALLEY WA
99037-9754
US

IV. Provider business mailing address

902 S SULLIVAN RD
SPOKANE VALLEY WA
99037-9754
US

V. Phone/Fax

Practice location:
  • Phone: 509-922-1909
  • Fax: 509-922-6648
Mailing address:
  • Phone: 509-833-1277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number61578019
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: