Provider Demographics
NPI:1629270582
Name:REGINA COSS DC
Entity Type:Organization
Organization Name:REGINA COSS DC
Other - Org Name:COMMUNITY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:JNN
Authorized Official - Last Name:COSS, D.C.
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-221-8700
Mailing Address - Street 1:1321 OLD BARN LN
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-5519
Mailing Address - Country:US
Mailing Address - Phone:972-786-1256
Mailing Address - Fax:972-221-8733
Practice Address - Street 1:403 W MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3772
Practice Address - Country:US
Practice Address - Phone:972-221-8700
Practice Address - Fax:972-221-8733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235155656OtherOTHER NPI NUMBER
TX608332OtherBCBS PROVIDER NUMBER