Provider Demographics
NPI:1396407342
Name:DR. KOLOSKI CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:DR. KOLOSKI CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:240-439-9764
Mailing Address - Street 1:2024 WEST ST STE 202
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3555
Mailing Address - Country:US
Mailing Address - Phone:240-439-9764
Mailing Address - Fax:
Practice Address - Street 1:2024 WEST ST STE 202
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3555
Practice Address - Country:US
Practice Address - Phone:240-439-9764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty