Provider Demographics
NPI:1669465043
Name:KOSAK, KEVIN RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:RICHARD
Last Name:KOSAK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14450 EAGLE RUN DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-1493
Mailing Address - Country:US
Mailing Address - Phone:402-964-0300
Mailing Address - Fax:402-964-0058
Practice Address - Street 1:14450 EAGLE RUN DR
Practice Address - Street 2:SUITE 150
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-1493
Practice Address - Country:US
Practice Address - Phone:402-964-0300
Practice Address - Fax:402-964-0058
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1298111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1002519300Medicaid
278533Medicare ID - Type Unspecified
U91257Medicare UPIN