Provider Demographics
NPI:1457449928
Name:KOWACHIK, JEFFREY ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
Last Name:KOWACHIK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 N GERMANTOWN PKWY
Mailing Address - Street 2:STE. 5
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-3307
Mailing Address - Country:US
Mailing Address - Phone:901-752-4300
Mailing Address - Fax:901-752-4466
Practice Address - Street 1:1740 N GERMANTOWN PKWY
Practice Address - Street 2:STE. 5
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-3307
Practice Address - Country:US
Practice Address - Phone:901-752-4300
Practice Address - Fax:901-752-4466
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9184111N00000X
TN2241111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL382178100Medicaid
TN3670072Medicare PIN