Provider Demographics
NPI:1013064716
Name:PROHEALTH CHIROPRACTIC & REHABILITATION, LLC
Entity Type:Organization
Organization Name:PROHEALTH CHIROPRACTIC & REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:MILIK
Authorized Official - Last Name:KOWALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:413-589-1110
Mailing Address - Street 1:360 SEWALL ST
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-2711
Mailing Address - Country:US
Mailing Address - Phone:413-589-1110
Mailing Address - Fax:413-589-1112
Practice Address - Street 1:360 SEWALL ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-2711
Practice Address - Country:US
Practice Address - Phone:413-589-1110
Practice Address - Fax:413-589-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3061111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty