MEDICARE: CRAIG ALLEN COSS D.C.

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	8210	AZ

General Provider Information

NPI Number	:	1881970697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG ALLEN COSS D.C.

Provider Business Mailing Address
First Line	:	361 CATCLAW LN
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5006
Country	:	US
Telephone Number	:	928-453-1367
Fax Number	:

Provider Business Practice Location Address
First Line	:	361 CATCLAW LN
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5006
Country	:	US
Telephone Number	:	928-453-1367
Fax Number	:

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

Provider Enumeration Date	:	10/25/2011
Last Update Date	:	10/25/2011

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