Provider Demographics
NPI:1902085244
Name:KOUIMANIS CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:KOUIMANIS CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:KOUIMANIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:219-662-9090
Mailing Address - Street 1:11039 BROADWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8834
Mailing Address - Country:US
Mailing Address - Phone:219-662-9090
Mailing Address - Fax:219-662-9191
Practice Address - Street 1:11039 BROADWAY
Practice Address - Street 2:SUITE C
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8834
Practice Address - Country:US
Practice Address - Phone:219-662-9090
Practice Address - Fax:219-662-9191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002329A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center