Provider Demographics
NPI:1740458272
Name:KOSTER, MICHAEL J (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:KOSTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:152 SIMSBURY RD # 12E
Mailing Address - Street 2:BUILDING 19
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3777
Mailing Address - Country:US
Mailing Address - Phone:860-677-1100
Mailing Address - Fax:860-677-1139
Practice Address - Street 1:152 SIMSBURY RD # 12E
Practice Address - Street 2:BUILDING 19
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3777
Practice Address - Country:US
Practice Address - Phone:860-677-1100
Practice Address - Fax:860-677-1139
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT001557111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition