Provider Demographics
NPI:1205171915
Name:KOSTERS, DEREK LEE (DC)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:LEE
Last Name:KOSTERS
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 1:715 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:51250-1349
Mailing Address - Country:US
Mailing Address - Phone:712-717-5101
Mailing Address - Fax:712-717-5101
Practice Address - Street 1:715 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CENTER
Practice Address - State:IA
Practice Address - Zip Code:51250-1349
Practice Address - Country:US
Practice Address - Phone:712-717-5101
Practice Address - Fax:712-717-5102
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007606111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor