Provider Demographics
NPI:1518964394
Name:KOSHICK, JAMES P (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:P
Last Name:KOSHICK
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 1:15800 W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-5121
Mailing Address - Country:US
Mailing Address - Phone:262-785-8989
Mailing Address - Fax:262-785-8992
Practice Address - Street 1:15800 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-5121
Practice Address - Country:US
Practice Address - Phone:262-785-8989
Practice Address - Fax:262-785-8992
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2505-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38849600Medicaid
WI68035Medicare ID - Type Unspecified
WI38849600Medicaid