Provider Demographics
NPI:1346242914
Name:KOSKINEN, WAYNE FRANK (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:FRANK
Last Name:KOSKINEN
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 1:139 W INDIANA AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1583
Mailing Address - Country:US
Mailing Address - Phone:419-874-4463
Mailing Address - Fax:419-874-5244
Practice Address - Street 1:139 W INDIANA AVE
Practice Address - Street 2:STE 102
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1583
Practice Address - Country:US
Practice Address - Phone:419-874-4463
Practice Address - Fax:419-874-5244
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1510111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0915415Medicaid
OH0915415Medicaid
OHKO0668822Medicare ID - Type Unspecified