Provider Demographics
NPI:1861818171
Name:KOZIEL, JACOB (DC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:KOZIEL
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 1:14074 TRADE CENTER DR
Mailing Address - Street 2:SUITE 226
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4563
Mailing Address - Country:US
Mailing Address - Phone:317-770-5775
Mailing Address - Fax:
Practice Address - Street 1:316 MAIN ST
Practice Address - Street 2:
Practice Address - City:BEECH GROVE
Practice Address - State:IN
Practice Address - Zip Code:46107-1836
Practice Address - Country:US
Practice Address - Phone:317-731-7826
Practice Address - Fax:317-731-7826
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002764A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor