Provider Demographics
NPI:1528115151
Name:COSLIC, TERRY L (DC)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:COSLIC
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 1:307 BUCKSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:STOYSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15563-8253
Mailing Address - Country:US
Mailing Address - Phone:814-267-3501
Mailing Address - Fax:814-267-5883
Practice Address - Street 1:307 BUCKSTOWN RD
Practice Address - Street 2:
Practice Address - City:STOYSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15563-8253
Practice Address - Country:US
Practice Address - Phone:814-267-3501
Practice Address - Fax:814-267-5883
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001720L111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACO042816OtherCHIROPRACTOR
PACO042816OtherCHIROPRACTOR