Provider Demographics
NPI:1487701371
Name:KOSLOSKI, JOHN M (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:KOSLOSKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1313 EAST SIBLEY BLVD
Mailing Address - Street 2:#108
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419
Mailing Address - Country:US
Mailing Address - Phone:708-841-0123
Mailing Address - Fax:708-841-0123
Practice Address - Street 1:1313 EAST SIBLEY BLVD
Practice Address - Street 2:#108
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419
Practice Address - Country:US
Practice Address - Phone:708-841-0123
Practice Address - Fax:708-841-0123
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL995480Medicare ID - Type Unspecified