Provider Demographics
NPI:1467639344
Name:KOTZAN, PHILLIP DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:DAVID
Last Name:KOTZAN
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 1:1150 WHITE OAK WAY
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-5109
Mailing Address - Country:US
Mailing Address - Phone:650-593-3500
Mailing Address - Fax:650-593-3355
Practice Address - Street 1:1150 WHITE OAK WAY
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-5109
Practice Address - Country:US
Practice Address - Phone:650-593-3500
Practice Address - Fax:650-593-3355
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor