MEDICARE: DR. SCOTT THOMAS KOZLOWSKI D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X008688-1	NY

General Provider Information

NPI Number	:	1043210529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT THOMAS KOZLOWSKI D.C.

Provider Business Mailing Address
First Line	:	451 S MAIN ST
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-2811
Country	:	US
Telephone Number	:	315-214-0404
Fax Number	:	315-214-0405

Provider Business Practice Location Address
First Line	:	451 S MAIN ST
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-2811
Country	:	US
Telephone Number	:	315-214-0404
Fax Number	:	315-214-0405

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	05/04/2012

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