Provider Demographics
NPI:1528463510
Name:KOSEK, JASON SCOTT (D C)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:SCOTT
Last Name:KOSEK
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 S MARLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-3302
Mailing Address - Country:US
Mailing Address - Phone:815-485-8200
Mailing Address - Fax:815-485-8996
Practice Address - Street 1:195 S MARLEY RD
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-3302
Practice Address - Country:US
Practice Address - Phone:815-485-8200
Practice Address - Fax:815-485-8996
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012713111N00000X
IN08002808A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor