Provider Demographics
NPI:1598819757
Name:COZZO, ROCKY ALLEN (DC)
Entity Type:Individual
Prefix:
First Name:ROCKY
Middle Name:ALLEN
Last Name:COZZO
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:PO BOX 1296
Mailing Address - Street 2:
Mailing Address - City:ANGELS CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95222-1296
Mailing Address - Country:US
Mailing Address - Phone:209-736-2819
Mailing Address - Fax:209-736-1544
Practice Address - Street 1:1209 HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:ANGELS CAMP
Practice Address - State:CA
Practice Address - Zip Code:95222-1296
Practice Address - Country:US
Practice Address - Phone:209-736-2819
Practice Address - Fax:209-736-1544
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0256820Medicare ID - Type Unspecified
CAU72900Medicare UPIN