Provider Demographics
NPI:1457403172
Name:KOWALSKI, WILLIAM J (DC FACO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:KOWALSKI
Suffix:
Gender:M
Credentials:DC FACO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12655 WOODFOREST BLVD
Mailing Address - Street 2:#200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015
Mailing Address - Country:US
Mailing Address - Phone:713-451-1400
Mailing Address - Fax:713-451-1411
Practice Address - Street 1:12655 WOODFOREST BLVD
Practice Address - Street 2:#200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015
Practice Address - Country:US
Practice Address - Phone:713-451-1400
Practice Address - Fax:713-451-1411
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2889111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046155001Medicaid
DE6464OtherMEDICARE GROUP
4361054OtherAETNA INS
NAOtherOWCP
87W330 8K0780OtherBC BS
P00306296OtherRAILROAD
TX431092OtherUNITED HC
4361054OtherAETNA INS
DE6464OtherMEDICARE GROUP