Healthcare Provider Details

I. General information

NPI: 1265440051
Provider Name (Legal Business Name): JAMES R KOTASKA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 11/02/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 3RD ST BAYNE-JONES ARMY COMMUNITY HOSPITAL
FT POLK LA
71459
US

IV. Provider business mailing address

411 EISSMAN RD APT 16 # 16
LEESVILLLE LA
71446-5439
US

V. Phone/Fax

Practice location:
  • Phone: 337-531-3823
  • Fax:
Mailing address:
  • Phone: 337-397-4451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH5330
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: