Provider Demographics
NPI:1386295848
Name:KOBY CHIRO PLLC
Entity type:Organization
Organization Name:KOBY CHIRO PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KOBY
Authorized Official - Middle Name:D
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-620-1705
Mailing Address - Street 1:1095 WEST ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-1023
Mailing Address - Country:US
Mailing Address - Phone:860-620-1705
Mailing Address - Fax:860-620-1746
Practice Address - Street 1:1095 WEST ST UNIT 1
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-1023
Practice Address - Country:US
Practice Address - Phone:860-620-1705
Practice Address - Fax:860-620-1746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty