Provider Demographics
NPI:1881789733
Name:KOSSIAN, MARK BAYARD (DC, DACS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:BAYARD
Last Name:KOSSIAN
Suffix:
Gender:M
Credentials:DC, DACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-4023
Mailing Address - Country:US
Mailing Address - Phone:425-775-6977
Mailing Address - Fax:
Practice Address - Street 1:127 AVENUE C STE A
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2768
Practice Address - Country:US
Practice Address - Phone:360-568-4185
Practice Address - Fax:360-568-2377
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0176018OtherLABOR & INDUSTRIES
WAKO2585OtherREGENCE
WA0176018OtherLABOR & INDUSTRIES