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General NPI Number Information
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NPI Number | 1124292909
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Entity Type | Individual
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Provider Name | JOHN JOSEPH PROKOSCH D.C.
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Gender | Male
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 232 MAIN ST E
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City | SLEEPY EYE
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State | MN
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Zip | 56085-1690
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Country | US
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Telephone | 507-766-2258
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Fax |
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Provider Business Mailing Address
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Address Line | 232 MAIN ST E
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City | SLEEPY EYE
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State | MN
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Zip | 56085-1690
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Country | US
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Telephone | 507-766-2258
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4452
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH 9133
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License Number State | FL
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