Provider Demographics
NPI:1154574499
Name:KOSTER FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:KOSTER FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-677-1100
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty