Provider Demographics
NPI:1659563294
Name:BASKIN, COSHUN (DC)
Entity Type:Individual
Prefix:DR
First Name:COSHUN
Middle Name:
Last Name:BASKIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 W. 212TH PLACE
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443
Mailing Address - Country:US
Mailing Address - Phone:708-466-5535
Mailing Address - Fax:
Practice Address - Street 1:3610 W. 212TH PLACE
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443
Practice Address - Country:US
Practice Address - Phone:708-466-5535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor