Provider Demographics
NPI:1720103997
Name:KOSMYNA, THOMAS STEVEN (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:STEVEN
Last Name:KOSMYNA
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:PO BOX L
Mailing Address - Street 2:301 W MICHIGAN AVE
Mailing Address - City:CLINTON
Mailing Address - State:MI
Mailing Address - Zip Code:49236
Mailing Address - Country:US
Mailing Address - Phone:517-456-7411
Mailing Address - Fax:517-456-7896
Practice Address - Street 1:301 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MI
Practice Address - Zip Code:49236
Practice Address - Country:US
Practice Address - Phone:517-456-7411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITK002768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T33078OtherUPIN
0D65018OtherBCBSM
T33078OtherUPIN