Provider Demographics
NPI:1316017312
Name:COZZOCREA, DENNIS M (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:M
Last Name:COZZOCREA
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 1:9370 SW GREENBURG ROAD
Mailing Address - Street 2:SUITE N
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223
Mailing Address - Country:US
Mailing Address - Phone:503-977-9975
Mailing Address - Fax:503-506-5013
Practice Address - Street 1:9370 SW GREENBURG RD
Practice Address - Street 2:SUITE N
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5442
Practice Address - Country:US
Practice Address - Phone:503-977-9975
Practice Address - Fax:503-506-5013
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002538111N00000X
OR5688111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA70825OtherL & I
336954900OtherFEDERAL L & I
350037378OtherRAILROAD MEDICARE
OH91150448300OtherBETTERS WORKERS COMP
336954900OtherFEDERAL L & I
U11487Medicare UPIN