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General NPI Number Information
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NPI Number | 1952442782
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Entity Type | Organization
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Legal Business Name | KOSTELECKY CHIROPRACTIC CLINIC INC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | 383 15TH ST W
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City | DICKINSON
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State | ND
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Zip | 58601-3017
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Country | US
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Telephone | 701-225-3536
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Fax |
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Provider Business Mailing Address
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Address Line | 383 15TH ST W
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City | DICKINSON
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State | ND
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Zip | 58601-3017
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Country | US
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Telephone | 701-225-3536
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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. JON MICHAEL KOSTELECKY
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Credential | D.C.
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Telephone | 701-225-3536
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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 | 555
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License Number State | ND
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