Healthcare Provider Details

I. General information

NPI: 1770718520
Provider Name (Legal Business Name): EDWARD A KOZAR DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E MCDOWELL RD STE 100
PHOENIX AZ
85006-2621
US

IV. Provider business mailing address

212 E PASEO WAY
TEMPE AZ
85283-3622
US

V. Phone/Fax

Practice location:
  • Phone: 480-652-1083
  • Fax:
Mailing address:
  • Phone: 480-652-1083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7852
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: