Provider Demographics
NPI:1003214917
Name:KOZMAN, TRENT GREGORY (DC)
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:GREGORY
Last Name:KOZMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 YORKTOWNE BLVD APT 1506
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-6058
Mailing Address - Country:US
Mailing Address - Phone:740-403-9150
Mailing Address - Fax:
Practice Address - Street 1:2741 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-3539
Practice Address - Country:US
Practice Address - Phone:740-403-9150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor