Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 29669 | CA |
NPI | 1497989925 |
---|---|
Provider Name | Dr. Kenneth Stan Kowaleski |
First Address | Rancho Cordova, CA 95670-2233 |
Second Address | El Dorado Hills, CA 95762-9331 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2009 |
Last Update Date | 12/05/2009 |