Provider Demographics
NPI:1740356922
Name:KOWALSKI, MICHAEL ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:KOWALSKI
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 1:8006 SHEPHERDSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-4050
Mailing Address - Country:US
Mailing Address - Phone:502-964-9800
Mailing Address - Fax:502-964-1847
Practice Address - Street 1:8006 SHEPHERDSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-4050
Practice Address - Country:US
Practice Address - Phone:502-964-9800
Practice Address - Fax:502-964-1847
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4524111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7189402OtherAETNA
KY85002483Medicaid
KY50000867OtherPASSPORT HEALTHPLAN GROUP
KY613993OtherACN GROUP
KY50000868OtherPASSPORT HEALTHPLAN INDIV
KY000000275184OtherANTHEM BCBS
KY3463110OtherCIGNA
KY613993OtherUNITED HEALTHCARE
KY613993OtherUNITED HEALTHCARE
KY3463110OtherCIGNA
KY0741801Medicare ID - Type UnspecifiedINDIVIDUAL PART B