Provider Demographics
NPI:1598951147
Name:GEORGE K KOSMIDES DC INC PROFESSION OF CHIROPRACTIC
Entity Type:Organization
Organization Name:GEORGE K KOSMIDES DC INC PROFESSION OF CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:K
Authorized Official - Last Name:KOSMIDES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:808-960-8283
Mailing Address - Street 1:4849 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2110
Mailing Address - Country:US
Mailing Address - Phone:818-788-4325
Mailing Address - Fax:818-206-8623
Practice Address - Street 1:4849 VAN NUYS BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2110
Practice Address - Country:US
Practice Address - Phone:818-788-4325
Practice Address - Fax:818-206-8623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6216720001Medicare NSC
CABK891Medicare PIN