Provider Demographics
NPI:1700975695
Name:KOWARSKI, ALLEN W (DC)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:W
Last Name:KOWARSKI
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 1:3970 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-291-6677
Mailing Address - Fax:703-649-6411
Practice Address - Street 1:3970 WALNUT ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-291-6677
Practice Address - Fax:703-649-6411
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA147411Medicare PIN
VA077310Medicare PIN