Provider Demographics
NPI:1982320099
Name:KOWALUK, ALEXA EVANKA (DC)
Entity Type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:EVANKA
Last Name:KOWALUK
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 1:1823 CHERRY BLOSSOM DR APT 204
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-3065
Mailing Address - Country:US
Mailing Address - Phone:503-505-8423
Mailing Address - Fax:
Practice Address - Street 1:680 MITCHELL WAY UNIT 160
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516
Practice Address - Country:US
Practice Address - Phone:303-469-2236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0008584111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor