Provider Demographics
NPI:1467576546
Name:COZART, TISHA A (DC)
Entity Type:Individual
Prefix:
First Name:TISHA
Middle Name:A
Last Name:COZART
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 CHRIS GAUPP DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4464
Mailing Address - Country:US
Mailing Address - Phone:609-404-7797
Mailing Address - Fax:609-404-7790
Practice Address - Street 1:314 CHRIS GAUPP DR
Practice Address - Street 2:SUITE 201
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4464
Practice Address - Country:US
Practice Address - Phone:609-404-7797
Practice Address - Fax:609-404-7790
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2012-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC088762111NI0900X
PADC008762111NN0400X, 111NR0200X, 111NR0400X, 111NS0005X, 111NT0100X, 111NX0100X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NI0900XChiropractic ProvidersChiropractorInternist
No111NN0400XChiropractic ProvidersChiropractorNeurology
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NT0100XChiropractic ProvidersChiropractorThermography
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030414OtherHEALTH ASSURANCE
PA055089WZ9OtherMEDICARE
PA6235788-001OtherCIGNA
PA1354319OtherBLUE CROSS