Provider Demographics
NPI:1740351071
Name:KALKOWSKI, VINCENT J (DC)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:J
Last Name:KALKOWSKI
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 1:1408 17TH ST
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-4303
Mailing Address - Country:US
Mailing Address - Phone:307-587-1500
Mailing Address - Fax:307-587-5073
Practice Address - Street 1:1408 17TH ST
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4303
Practice Address - Country:US
Practice Address - Phone:307-587-1500
Practice Address - Fax:307-587-5073
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY564111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY311052OtherBLUE CROSS BLUE SHIELD
WY830336389OtherEIN TAX ID
WY830336389OtherEIN TAX ID