=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699979716
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINA LORI KOSSWIG D.C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2007
-----------------------------------------------------
Last Update Date | 03/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1031 FARMINGTON AVE
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06032-1511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-409-0525
-----------------------------------------------------
Fax | 860-409-0419
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 BARWOOD MNR
-----------------------------------------------------
City | UNIONVILLE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06085-1211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-655-8277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 001748
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------