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General NPI Number Information
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NPI Number | 1154574499
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Entity Type | Organization
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Legal Business Name | KOSTER FAMILY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 10/30/2008
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Last Update Date | 02/25/2021
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Provider Practice Location Address
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Address Line | 152 SIMSBURY RD # 12E BUILDING 19
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City | AVON
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State | CT
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Zip | 06001-3777
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Country | US
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Telephone | 860-677-1100
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Fax | 860-677-1139
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Provider Business Mailing Address
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Address Line | 152 SIMSBURY RD # 12E BUILDING 19
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City | AVON
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State | CT
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Zip | 06001-3777
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Country | US
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Telephone | 860-677-1100
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Fax | 860-677-1139
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL J KOSTER
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Credential | D.C.
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Telephone | 860-677-1100
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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 | 001557
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License Number State | CT
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