Provider Demographics
NPI:1114927555
Name:KOZLOWSKI, KENNETH MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MICHAEL
Last Name:KOZLOWSKI
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 1:2909 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-2103
Mailing Address - Country:US
Mailing Address - Phone:727-823-7308
Mailing Address - Fax:727-824-8855
Practice Address - Street 1:2909 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-2103
Practice Address - Country:US
Practice Address - Phone:727-823-7308
Practice Address - Fax:727-824-8855
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH-5134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380607300Medicaid
FL4405292OtherUHC
FL517289OtherFIRST HEALTH NETWORD
FL5056815OtherCCM
FL70742OtherBCBS
FL4480189OtherAETNA
FL5056815OtherCCM
FL380607300Medicaid