Provider Demographics
NPI:1598916561
Name:ALLEN KOWARSKI, CHIROPRACTOR
Entity Type:Organization
Organization Name:ALLEN KOWARSKI, CHIROPRACTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:KOWARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-352-4357
Mailing Address - Street 1:3970 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4726
Mailing Address - Country:US
Mailing Address - Phone:703-352-4357
Mailing Address - Fax:703-352-8935
Practice Address - Street 1:3970 WALNUT ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4726
Practice Address - Country:US
Practice Address - Phone:703-352-4357
Practice Address - Fax:703-352-8935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA147411Medicare PIN