Healthcare Provider Details

I. General information

NPI: 1851223614
Provider Name (Legal Business Name): DYLAN KOSMACHUK DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3341 E QUEEN CREEK RD STE 109
GILBERT AZ
85297-8510
US

IV. Provider business mailing address

3341 E QUEEN CREEK RD STE 109
GILBERT AZ
85297-8510
US

V. Phone/Fax

Practice location:
  • Phone: 480-842-5020
  • Fax:
Mailing address:
  • Phone: 480-842-5020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number009552
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: