Provider Demographics
NPI:1609310119
Name:WALKOWIAK, KASSANDRA (DC)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:
Last Name:WALKOWIAK
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 1:2428 SANTA MONICA BLVD STE 308
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2046
Mailing Address - Country:US
Mailing Address - Phone:310-453-8393
Mailing Address - Fax:310-453-8696
Practice Address - Street 1:2428 SANTA MONICA BLVD STE 308
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2046
Practice Address - Country:US
Practice Address - Phone:310-453-8393
Practice Address - Fax:310-453-8696
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33749111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor