Provider Demographics
NPI:1831157676
Name:KOWALCZYK, ANGELA CHRISTINE (DC)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:CHRISTINE
Last Name:KOWALCZYK
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 1:201 W GUADALUPE RD STE 301
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3333
Mailing Address - Country:US
Mailing Address - Phone:480-892-7500
Mailing Address - Fax:480-892-7501
Practice Address - Street 1:201 W GUADALUPE RD STE 301
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3333
Practice Address - Country:US
Practice Address - Phone:480-892-7500
Practice Address - Fax:480-892-7501
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7489111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ85230Medicare ID - Type UnspecifiedPROVIDER #