Provider Demographics
NPI:1336193804
Name:NOWAKOWSKI, ANTOINETTE HATALA (DC, DABCO)
Entity Type:Individual
Prefix:DR
First Name:ANTOINETTE
Middle Name:HATALA
Last Name:NOWAKOWSKI
Suffix:
Gender:F
Credentials:DC, DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 S CAMINO DEL RIO
Mailing Address - Street 2:SUITE G
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-7935
Mailing Address - Country:US
Mailing Address - Phone:970-259-0077
Mailing Address - Fax:970-259-6540
Practice Address - Street 1:329 S CAMINO DEL RIO
Practice Address - Street 2:SUITE G
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-7935
Practice Address - Country:US
Practice Address - Phone:970-259-0077
Practice Address - Fax:970-259-6540
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2007-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2357111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC23103Medicare UPIN