Provider Demographics
NPI:1104914068
Name:KOSLOWSKI, DENNIS MARVIN (DC)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:MARVIN
Last Name:KOSLOWSKI
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 1:312 CENTRAL AVENUE SE
Mailing Address - Street 2:SUITE 468
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414
Mailing Address - Country:US
Mailing Address - Phone:612-379-4043
Mailing Address - Fax:612-379-4398
Practice Address - Street 1:312 CENTRAL AVENUE SE
Practice Address - Street 2:SUITE 468
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414
Practice Address - Country:US
Practice Address - Phone:612-379-4043
Practice Address - Fax:612-379-4398
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2326111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0H129KOOtherBLUE CROSS BLUE SHIELD
U08291Medicare UPIN