Provider Demographics
NPI:1265440051
Name:KOTASKA, JAMES R (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:KOTASKA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:411 EISSMAN RD APT 16
Mailing Address - Street 2:# 16
Mailing Address - City:LEESVILLLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-5439
Mailing Address - Country:US
Mailing Address - Phone:337-397-4451
Mailing Address - Fax:
Practice Address - Street 1:1585 3RD ST
Practice Address - Street 2:BAYNE-JONES ARMY COMMUNITY HOSPITAL
Practice Address - City:FT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459
Practice Address - Country:US
Practice Address - Phone:337-531-3823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3801781 00Medicaid
FL3801781 00Medicaid
26664Medicare UPIN