Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 5256 | KY |
N | 111NR0400X | Rehabilitation Chiropractor | 5256 | KY |
N | 111NS0005X | Chiropractic Sports Physician | 5256 | KY |
NPI | 1407166929 |
---|---|
Provider Name | Ross Alan Kowzan |
First Address | Louisville, KY 40299 |
Second Address | Louisville, KY 40207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2010 |
Last Update Date | 18/10/2010 |