Provider Demographics
NPI:1447592738
Name:COSCOLLUELA, KAREN ANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ANNE
Last Name:COSCOLLUELA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11340 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 138
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1608
Mailing Address - Country:US
Mailing Address - Phone:310-473-4400
Mailing Address - Fax:
Practice Address - Street 1:11340 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 138
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1608
Practice Address - Country:US
Practice Address - Phone:310-473-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 32528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor