Provider Demographics
NPI:1609168087
Name:DR. MISTY KOSCIUSKO DBA NEW HORIZON CHIROPRACTIC & WELLNESS
Entity Type:Organization
Organization Name:DR. MISTY KOSCIUSKO DBA NEW HORIZON CHIROPRACTIC & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:BECK
Authorized Official - Last Name:KOSCIUSKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS
Authorized Official - Phone:401-474-0423
Mailing Address - Street 1:934 E MAIN RD
Mailing Address - Street 2:UNIT A
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-2341
Mailing Address - Country:US
Mailing Address - Phone:401-474-0423
Mailing Address - Fax:
Practice Address - Street 1:934 E MAIN RD
Practice Address - Street 2:UNIT A
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-2341
Practice Address - Country:US
Practice Address - Phone:401-474-0423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDC00594302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0020475Medicare PIN