Provider Demographics
NPI:1013196286
Name:KOUIMANIS, STEVEN G (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:G
Last Name:KOUIMANIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11039 BROADWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8834
Mailing Address - Country:US
Mailing Address - Phone:219-662-9090
Mailing Address - Fax:219-662-9191
Practice Address - Street 1:11039 BROADWAY
Practice Address - Street 2:SUITE C
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8834
Practice Address - Country:US
Practice Address - Phone:219-662-9090
Practice Address - Fax:219-662-9191
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002329A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor