1932381746 NPI number — JOHN N. KOSTIDIS

Table of content: (NPI 1932381746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932381746 NPI number — JOHN N. KOSTIDIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN N. KOSTIDIS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932381746
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2387
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALPARAISO
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46384-2387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-465-1140
Provider Business Mailing Address Fax Number:
219-465-0903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4004 CAMPBELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALPARAISO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46385-1773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-465-1140
Provider Business Practice Location Address Fax Number:
219-465-0903
Provider Enumeration Date:
12/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KOSTIDIS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
N
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
219-465-1140

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  08000556A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 084890 . This is a "MEDICARE GRP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000488762 . This is a "ANTHEM IND" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1467491209 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1801819305 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 4471101 . This is a "AETNA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 667535 . This is a "ACN IND" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000283870 . This is a "ANTHEM IND" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000284649 . This is a "ANTHEM IND" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1639128929 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200441700A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 609638 . This is a "ACN IND" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 603682 . This is a "ACN IND" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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