MEDICARE: MRS. KIMBERLY COWDRICK D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	010882	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000228056001	OTHER	NY	BLUE CROSS

General Provider Information

NPI Number	:	1053444992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY COWDRICK D.C.

Provider Business Mailing Address
First Line	:	1761 ORCHARD PARK RD
Second Line	:
City	:	WEST SENECA
State	:	NY
Zip	:	14224-4624
Country	:	US
Telephone Number	:	716-674-0821
Fax Number	:	716-674-0293

Provider Business Practice Location Address
First Line	:	1761 ORCHARD PARK RD
Second Line	:
City	:	WEST SENECA
State	:	NY
Zip	:	14224-4624
Country	:	US
Telephone Number	:	716-674-0821
Fax Number	:	716-674-0293

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/09/2007

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