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General NPI Number Information
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NPI Number | 1205171915
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Entity Type | Individual
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Provider Name | DEREK LEE KOSTERS D.C.
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Gender | Male
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Dates
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Enumeration Date | 12/06/2012
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 715 S MAIN AVE
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City | SIOUX CENTER
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State | IA
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Zip | 51250-1349
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Country | US
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Telephone | 712-717-5101
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Fax | 712-717-5102
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Provider Business Mailing Address
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Address Line | 715 S MAIN AVE
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City | SIOUX CENTER
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State | IA
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Zip | 51250-1349
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Country | US
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Telephone | 712-717-5101
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Fax | 712-717-5101
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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 | 007606
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License Number State | IA
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