Provider Demographics
NPI:1740412881
Name:GOZENPUD, OLEG (DC)
Entity Type:Individual
Prefix:DR
First Name:OLEG
Middle Name:
Last Name:GOZENPUD
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 1:3850 NW 2ND AVE SUITE 22
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-3809
Mailing Address - Country:US
Mailing Address - Phone:212-308-0561
Mailing Address - Fax:
Practice Address - Street 1:3850 NW 2ND AVE STE 22
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-5865
Practice Address - Country:US
Practice Address - Phone:212-308-0561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011705111N00000X
FLCH13308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor