Healthcare Provider Details

I. General information

NPI: 1356844807
Provider Name (Legal Business Name): KOZIARSKI CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 W 8TH ST STE A-5
ERIE PA
16505-5005
US

IV. Provider business mailing address

1535 W 8TH ST STE A-5
ERIE PA
16505-5005
US

V. Phone/Fax

Practice location:
  • Phone: 814-897-3102
  • Fax:
Mailing address:
  • Phone: 814-897-3102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC010551
License Number StatePA

VIII. Authorized Official

Name: KARIN TONER PIERCE
Title or Position: BILLING MRG
Credential:
Phone: 610-942-4440