Provider Demographics
NPI:1245813658
Name:KOVACICH, LOWELL THOMAS (DC, ATC)
Entity type:Individual
Prefix:DR
First Name:LOWELL
Middle Name:THOMAS
Last Name:KOVACICH
Suffix:
Gender:M
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 S SULLIVAN RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-9754
Mailing Address - Country:US
Mailing Address - Phone:509-833-1277
Mailing Address - Fax:
Practice Address - Street 1:902 S SULLIVAN RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-9754
Practice Address - Country:US
Practice Address - Phone:509-922-1909
Practice Address - Fax:509-922-6648
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2024-08-02
Deactivation Date:2024-07-15
Deactivation Code:
Reactivation Date:2024-07-31
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
WA61578019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer