Provider Demographics
NPI:1114902335
Name:MCKOLOSKY, DENNIS G (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:G
Last Name:MCKOLOSKY
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 1:401 THEATRE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-2838
Mailing Address - Country:US
Mailing Address - Phone:814-269-3116
Mailing Address - Fax:814-266-8471
Practice Address - Street 1:401 THEATRE DR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-2838
Practice Address - Country:US
Practice Address - Phone:814-269-3116
Practice Address - Fax:814-266-8471
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003276L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001418825002Medicaid
T30625Medicare UPIN
PA001418825002Medicaid
PA1114902335Medicare NSC