Healthcare Provider Details

I. General information

NPI: 1124946371
Provider Name (Legal Business Name): STEPHANIE MARIE KOZLOSKI DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W STEUBEN ST STE 1
BINGEN WA
98605-9175
US

IV. Provider business mailing address

PO BOX 252
BINGEN WA
98605-0252
US

V. Phone/Fax

Practice location:
  • Phone: 509-493-0555
  • Fax:
Mailing address:
  • Phone: 509-493-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR.CH.70111198
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: