Provider Demographics
NPI:1558416230
Name:KOSAK CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:KOSAK CHIROPRACTIC P.C.
Other - Org Name:KOSAK CHIROPRACTIC & ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:KOSAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-964-0300
Mailing Address - Street 1:14450 EAGLE RUN DR
Mailing Address - Street 2:STE. 150
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-1493
Mailing Address - Country:US
Mailing Address - Phone:402-964-0300
Mailing Address - Fax:402-964-0058
Practice Address - Street 1:14450 EAGLE RUN DR
Practice Address - Street 2:STE. 150
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-1493
Practice Address - Country:US
Practice Address - Phone:402-964-0300
Practice Address - Fax:402-964-0058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEDC7658OtherRAILROAD MEDICARE GROUP #
NEDC7658OtherRAILROAD MEDICARE GROUP #