Provider Demographics
NPI:1750508784
Name:MARCINKOWSKI, KEVIN MICHEAL (D C)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHEAL
Last Name:MARCINKOWSKI
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 ALT 19
Mailing Address - Street 2:SUITE D
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-5303
Mailing Address - Country:US
Mailing Address - Phone:727-787-2285
Mailing Address - Fax:
Practice Address - Street 1:350 ALT 19
Practice Address - Street 2:SUITE D
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-5303
Practice Address - Country:US
Practice Address - Phone:727-787-2285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9077111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor