MEDICARE: YELENA KOZLYANSKY 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	X010979	NY

General Provider Information

NPI Number	:	1427143296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YELENA KOZLYANSKY D.C.

Provider Business Mailing Address
First Line	:	77 FRONT ST FL 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-1006
Country	:	US
Telephone Number	:	646-318-1884
Fax Number	:	718-504-7630

Provider Business Practice Location Address
First Line	:	77 FRONT ST FL 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-1006
Country	:	US
Telephone Number	:	646-318-1884
Fax Number	:	718-504-7630

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	12/13/2011

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