Provider Demographics
NPI:1043359607
Name:KOSMIDER, STEVEN EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:EDWARD
Last Name:KOSMIDER
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 1:1401 MARVIN RD NE
Mailing Address - Street 2:#107
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5709
Mailing Address - Country:US
Mailing Address - Phone:360-459-5990
Mailing Address - Fax:360-456-0222
Practice Address - Street 1:1401 MARVIN RD NE
Practice Address - Street 2:#107
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-5709
Practice Address - Country:US
Practice Address - Phone:360-459-5990
Practice Address - Fax:360-456-0222
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002159111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB15289Medicare ID - Type Unspecified
WAT02040Medicare UPIN