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General NPI Number Information
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NPI Number | 1437212800
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Entity Type | Organization
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Legal Business Name | KOSTERMAN CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 116 COUNTRY CLUB DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-7604
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Country | US
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Telephone | 910-229-1952
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Fax |
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Provider Business Mailing Address
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Address Line | 116 COUNTRY CLUB DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-7604
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Country | US
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Telephone | 910-229-1952
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL J KOSTERMAN
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Credential | DC
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Telephone | 910-229-1952
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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 | 930
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License Number State | NC
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