Healthcare Provider Details

I. General information

NPI: 1538846175
Provider Name (Legal Business Name): KOSEK KIRO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2023
Last Update Date: 07/04/2023
Certification Date: 07/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 S MARLEY RD
NEW LENOX IL
60451-3302
US

IV. Provider business mailing address

195 S MARLEY RD
NEW LENOX IL
60451-3302
US

V. Phone/Fax

Practice location:
  • Phone: 815-485-8200
  • Fax: 815-485-8996
Mailing address:
  • Phone: 815-485-8200
  • Fax: 815-485-8996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON S KOSEK
Title or Position: PRESIDENT
Credential: DC
Phone: 815-485-8200