MEDICARE: DR. ELIAS PETER KOTSOVOLOS 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	X007026	NY

General Provider Information

NPI Number	:	1407972995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIAS PETER KOTSOVOLOS D.C.

Provider Business Mailing Address
First Line	:	218 BROADWAY GREENLAWN
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-4601
Country	:	US
Telephone Number	:	631-543-5774
Fax Number	:

Provider Business Practice Location Address
First Line	:	218 BROADWAY GREENLAWN
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-4601
Country	:	US
Telephone Number	:	631-754-4410
Fax Number	:

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/09/2007

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