Provider Demographics
NPI:1649422932
Name:KOSTOW FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:KOSTOW FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:KOSTOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:3002-656-7179
Mailing Address - Street 1:1614 N BROOM ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-3010
Mailing Address - Country:US
Mailing Address - Phone:302-656-7179
Mailing Address - Fax:302-656-2727
Practice Address - Street 1:1614 N BROOM ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-3010
Practice Address - Country:US
Practice Address - Phone:302-656-7179
Practice Address - Fax:302-656-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10000486111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty