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General NPI Number Information
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NPI Number | 1548660160
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Entity Type | Organization
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Legal Business Name | KOSMYNA CHIROPRACTIC LIFE CENTER PC
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Dates
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Enumeration Date | 09/02/2014
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Last Update Date | 10/22/2014
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Provider Practice Location Address
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Address Line | 301 W MICHIGAN AVE
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City | CLINTON
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State | MI
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Zip | 49236-9502
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Country | US
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Telephone | 517-456-7411
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Fax | 517-456-7896
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Provider Business Mailing Address
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Address Line | 301 W MICHIGAN AVE
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City | CLINTON
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State | MI
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Zip | 49236-9502
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Country | US
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Telephone | 517-456-7411
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Fax | 517-456-7896
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. THOMAS STEVEN KOSMYNA
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Credential | DC
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Telephone | 517-456-7411
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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 | 2301002768
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License Number State | MI
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