Provider Demographics
NPI:1538314729
Name:KOWALKE, TERRY KEVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:KEVIN
Last Name:KOWALKE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6423 COLONY WAY
Mailing Address - Street 2:#2D
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2259
Mailing Address - Country:US
Mailing Address - Phone:952-956-2305
Mailing Address - Fax:
Practice Address - Street 1:2751 HENNEPIN AVE
Practice Address - Street 2:STE. 311
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-1002
Practice Address - Country:US
Practice Address - Phone:612-284-4535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5136111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor