Provider Demographics
NPI:1477567915
Name:KOSYCARZ, TERESA YVONNE (DC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:YVONNE
Last Name:KOSYCARZ
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 1:39872 LOS ALAMOS RD
Mailing Address - Street 2:A-8
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5871
Mailing Address - Country:US
Mailing Address - Phone:951-698-4034
Mailing Address - Fax:951-698-5076
Practice Address - Street 1:39872 LOS ALAMOS RD
Practice Address - Street 2:A-8
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5871
Practice Address - Country:US
Practice Address - Phone:951-698-4034
Practice Address - Fax:951-698-5076
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC213920Medicare UPIN
CADC213920Medicare ID - Type Unspecified