=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598951147
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GEORGE K KOSMIDES DC INC PROFESSION OF CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2007
-----------------------------------------------------
Last Update Date | 06/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4849 VAN NUYS BLVD SUITE 206
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91403-2110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-788-4325
-----------------------------------------------------
Fax | 818-206-8623
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4849 VAN NUYS BLVD SUITE 206
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91403-2110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-788-4325
-----------------------------------------------------
Fax | 818-206-8623
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GEORGE K KOSMIDES
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 808-960-8283
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------