MEDICARE: DR. RENATA ANNA KOWAL DC

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	0104556353	VA
2	111N00000X	Chiropractor	2301008778	MI

General Provider Information

NPI Number	:	1770576738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENATA ANNA KOWAL DC

Provider Business Mailing Address
First Line	:	640 DENBIGH BLVD
Second Line	:	SUITE 4
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23608-4485
Country	:	US
Telephone Number	:	586-899-7256
Fax Number	:	586-774-9583

Provider Business Practice Location Address
First Line	:	640 DENBIGH BLVD
Second Line	:	SUITE 4
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23608-4485
Country	:	US
Telephone Number	:	586-899-7256
Fax Number	:	586-774-9583

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	07/08/2007

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