Provider Demographics
NPI:1437210218
Name:SOTOS, KOSTA (DC)
Entity type:Individual
Prefix:DR
First Name:KOSTA
Middle Name:
Last Name:SOTOS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:DINO
Other - Middle Name:
Other - Last Name:SOTOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1845 OAK ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3022
Mailing Address - Country:US
Mailing Address - Phone:847-446-5420
Mailing Address - Fax:847-446-5426
Practice Address - Street 1:1845 OAK ST STE 1
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3022
Practice Address - Country:US
Practice Address - Phone:847-446-5420
Practice Address - Fax:847-446-5426
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008035111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK15523OtherPIN
ILU82351Medicare UPIN