Provider Demographics
NPI:1124292909
Name:PROKOSCH, JOHN JOSEPH (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:PROKOSCH
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 1:232 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:SLEEPY EYE
Mailing Address - State:MN
Mailing Address - Zip Code:56085-1690
Mailing Address - Country:US
Mailing Address - Phone:507-766-2258
Mailing Address - Fax:
Practice Address - Street 1:232 MAIN ST E
Practice Address - Street 2:
Practice Address - City:SLEEPY EYE
Practice Address - State:MN
Practice Address - Zip Code:56085-1690
Practice Address - Country:US
Practice Address - Phone:507-766-2258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4452111N00000X
FLCH 9133111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor