Healthcare Provider Details

I. General information

NPI: 1265733604
Provider Name (Legal Business Name): BETH JOY KOZAK D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4043 HOOD ROAD
PALM BEACH GARDENS FL
33410-2171
US

IV. Provider business mailing address

4043 HOOD ROAD
PALM BEACH GARDENS FL
33410-2171
US

V. Phone/Fax

Practice location:
  • Phone: 561-622-2466
  • Fax: 561-622-2606
Mailing address:
  • Phone: 561-622-2466
  • Fax: 561-622-2606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH7712
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH7712
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: