Provider Demographics
NPI:1932381746
Name:JOHN N. KOSTIDIS
Entity type:Organization
Organization Name:JOHN N. KOSTIDIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:N
Authorized Official - Last Name:KOSTIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:219-465-1140
Mailing Address - Street 1:PO BOX 2387
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46384-2387
Mailing Address - Country:US
Mailing Address - Phone:219-465-1140
Mailing Address - Fax:219-465-0903
Practice Address - Street 1:4004 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-1773
Practice Address - Country:US
Practice Address - Phone:219-465-1140
Practice Address - Fax:219-465-0903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000556A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN084890OtherMEDICARE GRP
IN000000488762OtherANTHEM IND
IN1467491209OtherANTHEM
IN1801819305OtherANTHEM
IN4471101OtherAETNA
IN667535OtherACN IND
IN000000283870OtherANTHEM IND
IN000000284649OtherANTHEM IND
IN1639128929OtherANTHEM
IN200441700AMedicaid
IN609638OtherACN IND
IN603682OtherACN IND
IN603682OtherACN IND
IN6594320001Medicare NSC