Provider Demographics
NPI:1770576738
Name:KOWAL, RENATA ANNA (DC)
Entity type:Individual
Prefix:DR
First Name:RENATA
Middle Name:ANNA
Last Name:KOWAL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 DENBIGH BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-4485
Mailing Address - Country:US
Mailing Address - Phone:586-899-7256
Mailing Address - Fax:586-774-9583
Practice Address - Street 1:640 DENBIGH BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-4485
Practice Address - Country:US
Practice Address - Phone:586-899-7256
Practice Address - Fax:586-774-9583
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556353111N00000X
MI2301008778111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU98597Medicare UPIN