Provider Demographics
NPI:1790980175
Name:KOS CHIROPRACTIC CENTER DC PC
Entity Type:Organization
Organization Name:KOS CHIROPRACTIC CENTER DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-484-7579
Mailing Address - Street 1:999 FOXON RD
Mailing Address - Street 2:UNIT 8
Mailing Address - City:NORTH BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06471-1287
Mailing Address - Country:US
Mailing Address - Phone:203-484-7579
Mailing Address - Fax:203-484-2686
Practice Address - Street 1:999 FOXON ROAD SUITE 8
Practice Address - Street 2:
Practice Address - City:NORTH BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06471
Practice Address - Country:US
Practice Address - Phone:203-484-7579
Practice Address - Fax:203-484-2686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT000885111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050000885CT04OtherANTHEM
CT631506OtherCTCARE
CT4112710Medicaid
CTP1227567OtherOXFORD
CT532967OtherAETNA
CT948313OtherHEALTHNET
CT4112710Medicaid