MEDICARE: DR. HEIDI LYN KOSAK DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1297	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114910593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEIDI LYN KOSAK DC

Provider Business Mailing Address
First Line	:	14450 EAGLE RUN DR
Second Line	:	SUITE 150
City	:	OMAHA
State	:	NE
Zip	:	68116-1493
Country	:	US
Telephone Number	:	402-964-0300
Fax Number	:	402-964-0058

Provider Business Practice Location Address
First Line	:	14450 EAGLE RUN DR
Second Line	:	SUITE 150
City	:	OMAHA
State	:	NE
Zip	:	68116-1493
Country	:	US
Telephone Number	:	402-964-0300
Fax Number	:	402-964-0058

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/15/2008

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Directions to “ DR. HEIDI LYN KOSAK DC” Practice Location

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