Provider Demographics
NPI:1366523243
Name:KOWALIK CHIROPRACTIC INC
Entity type:Organization
Organization Name:KOWALIK CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:G
Authorized Official - Last Name:KOWALIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-380-8883
Mailing Address - Street 1:25431 TRABUCO RD STE 4
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2779
Mailing Address - Country:US
Mailing Address - Phone:949-380-8883
Mailing Address - Fax:949-380-1308
Practice Address - Street 1:25431 TRABUCO RD
Practice Address - Street 2:4
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2787
Practice Address - Country:US
Practice Address - Phone:949-380-8883
Practice Address - Fax:949-380-1308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24455111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06836ZOtherBLUE SHIELD
CAZZZ06836ZOtherBLUE SHIELD
CAU87408Medicare UPIN