Provider Demographics
NPI:1942278981
Name:POGONOWSKI, KIM MARIE (DC)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:MARIE
Last Name:POGONOWSKI
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 1:365 36TH ST SE
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-2613
Mailing Address - Country:US
Mailing Address - Phone:727-786-8991
Mailing Address - Fax:727-784-1317
Practice Address - Street 1:2429 ALT. US 19 NO
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683
Practice Address - Country:US
Practice Address - Phone:727-786-8991
Practice Address - Fax:727-784-1317
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74889OtherMEDICARE GR
FL381797100Medicaid
FL74889OtherMEDICARE GR
FL88615Medicare ID - Type Unspecified