Provider Demographics
NPI:1528566999
Name:KOSSOVER FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:KOSSOVER FAMILY CHIROPRACTIC PLLC
Other - Org Name:SOULSHINE CHIROPRACTIC STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DC
Authorized Official - Prefix:
Authorized Official - First Name:LARA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOSSOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-832-7390
Mailing Address - Street 1:917 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:917 8TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4309
Practice Address - Country:US
Practice Address - Phone:718-832-7390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-31
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011558-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty