Provider Demographics
NPI:1629136981
Name:KOWACKI, PAUL ANTONI (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ANTONI
Last Name:KOWACKI
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 1:28 NORTH MAIN ST
Mailing Address - Street 2:PO BOX 118
Mailing Address - City:ORANGE
Mailing Address - State:MA
Mailing Address - Zip Code:01364-0118
Mailing Address - Country:US
Mailing Address - Phone:978-544-7902
Mailing Address - Fax:978-544-7902
Practice Address - Street 1:28 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:MA
Practice Address - Zip Code:01364-0118
Practice Address - Country:US
Practice Address - Phone:978-544-7902
Practice Address - Fax:978-544-7902
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA928111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
727902OtherTUFTS
MA1602713Medicaid
2993701OtherAETNA
18961OtherCIGNA
350264OtherHARVARD PILGRIM
612073OtherACN GROUP
46234OtherFALLON
4403000OtherUNITED HEALTH PLANS OF NE
2993701OtherAETNA
T58306Medicare UPIN