Healthcare Provider Details

I. General information

NPI: 1477677110
Provider Name (Legal Business Name): CRAIG GEORGE KOZAK DC, PA-C, MSPAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 BANNOCK ST FL 6
DENVER CO
80204-4506
US

IV. Provider business mailing address

1250 N PEARL ST APT 2
DENVER CO
80203-2539
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-1590
  • Fax:
Mailing address:
  • Phone: 720-841-1239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4879
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: