Provider Demographics
NPI:1053445643
Name:KOWALSKI, JANICE SYLVIA (DC)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:SYLVIA
Last Name:KOWALSKI
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 1:11 MAREBLU
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3044
Mailing Address - Country:US
Mailing Address - Phone:949-643-5030
Mailing Address - Fax:949-643-5209
Practice Address - Street 1:11 MAREBLU
Practice Address - Street 2:SUITE 230
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3044
Practice Address - Country:US
Practice Address - Phone:949-643-5030
Practice Address - Fax:949-643-5209
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15978111N00000X
CAPT8944225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC15978Medicare UPIN