Provider Demographics
NPI:1972808160
Name:COSSAR CHIROPRACTIC
Entity Type:Organization
Organization Name:COSSAR CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIRIPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:MACLIN
Authorized Official - Last Name:COSSAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-886-9616
Mailing Address - Street 1:PO BOX 941
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-1416
Mailing Address - Country:US
Mailing Address - Phone:706-886-9616
Mailing Address - Fax:706-282-0365
Practice Address - Street 1:2766 GA HWY 17
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577
Practice Address - Country:US
Practice Address - Phone:706-886-9616
Practice Address - Fax:706-282-0365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G350004OtherMEDICARE GROUP NUMBER
GA511I350016Medicare PIN