Provider Demographics
NPI:1134414469
Name:KOUSOULIS CHIROPRACTIC PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:KOUSOULIS CHIROPRACTIC PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUSOULIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-208-0101
Mailing Address - Street 1:1062 WESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-2903
Mailing Address - Country:US
Mailing Address - Phone:310-208-0101
Mailing Address - Fax:323-512-5228
Practice Address - Street 1:1062 WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-2903
Practice Address - Country:US
Practice Address - Phone:310-208-0101
Practice Address - Fax:323-512-5228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty