Provider Demographics
NPI:1235155656
Name:COSS, REGINA (DC)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:COSS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:BIERBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1321 OLD BARN LN
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-5519
Mailing Address - Country:US
Mailing Address - Phone:972-786-1256
Mailing Address - Fax:
Practice Address - Street 1:403 W MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3772
Practice Address - Country:US
Practice Address - Phone:972-221-8700
Practice Address - Fax:972-221-8733
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10448111N00000X
AZ7210111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX648297OtherACN PROVIDER NUMBER
TX8AJ833OtherBCBS PROVIDER NUMBER
TX00X420OtherMEDICARE P-TAN
TX648297OtherACN PROVIDER NUMBER
TX8AJ833OtherBCBS PROVIDER NUMBER
TX8F4737Medicare PIN