Provider Demographics
NPI:1053444992
Name:COWDRICK, KIMBERLY (DC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:COWDRICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 ORCHARD PARK RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-4624
Mailing Address - Country:US
Mailing Address - Phone:716-674-0821
Mailing Address - Fax:716-674-0293
Practice Address - Street 1:1761 ORCHARD PARK RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-4624
Practice Address - Country:US
Practice Address - Phone:716-674-0821
Practice Address - Fax:716-674-0293
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010882111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000228056001OtherBLUE CROSS
NYV01104Medicare UPIN
NYIA0587Medicare ID - Type UnspecifiedMEDICARE