Provider Demographics
NPI:1841350147
Name:KOSBAU, JOHN ROGER (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROGER
Last Name:KOSBAU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9345 WELLINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-6636
Mailing Address - Country:US
Mailing Address - Phone:916-773-2292
Mailing Address - Fax:916-773-2292
Practice Address - Street 1:2220 J ST STE 3
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4741
Practice Address - Country:US
Practice Address - Phone:916-443-2255
Practice Address - Fax:916-443-2292
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14849111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0148490Medicare ID - Type Unspecified
CAT05525Medicare UPIN