Healthcare Provider Details

I. General information

NPI: 1841350147
Provider Name (Legal Business Name): JOHN ROGER KOSBAU D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 J ST STE 3
SACRAMENTO CA
95816-4741
US

IV. Provider business mailing address

9345 WELLINGTON WAY
GRANITE BAY CA
95746-6636
US

V. Phone/Fax

Practice location:
  • Phone: 916-443-2255
  • Fax: 916-443-2292
Mailing address:
  • Phone: 916-773-2292
  • Fax: 916-773-2292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberDC14849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: