Provider Demographics
NPI:1639281058
Name:KOZIK, JOHN JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:KOZIK
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 1:1055 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-2038
Mailing Address - Country:US
Mailing Address - Phone:814-664-2216
Mailing Address - Fax:814-665-2040
Practice Address - Street 1:1055 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-2038
Practice Address - Country:US
Practice Address - Phone:814-664-2216
Practice Address - Fax:814-665-2040
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002990L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010101460001Medicaid
PA0010101460001Medicaid
PAT28582Medicare UPIN