Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 5110 | CO |
NPI | 1396821476 |
---|---|
Provider Name | Dr. Shane Ryan Kokoszka |
First Address | Denver, CO 80221-1907 |
Second Address | Westminster, CO 80021-5544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 08/07/2007 |