Provider Demographics
NPI:1063576023
Name:KOSHLAP, CRAIG EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:EDWARD
Last Name:KOSHLAP
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 1:17775 W 106TH ST
Mailing Address - Street 2:STE 105
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-3197
Mailing Address - Country:US
Mailing Address - Phone:913-890-7370
Mailing Address - Fax:913-890-7372
Practice Address - Street 1:17775 W 106TH ST
Practice Address - Street 2:STE 105
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-3197
Practice Address - Country:US
Practice Address - Phone:913-890-7370
Practice Address - Fax:913-890-7372
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4897111N00000X
FLCH 8111111N00000X
MO2004020267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO34120027OtherBLUE CROSS BLUE SHIELD
MO34120027OtherBLUE CROSS BLUE SHIELD
KSKA1704002Medicare PIN