MEDICARE: TERESA YVONNE KOSYCARZ DC

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	DC21392	CA

General Provider Information

NPI Number	:	1477567915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA YVONNE KOSYCARZ DC

Provider Business Mailing Address
First Line	:	39872 LOS ALAMOS RD
Second Line	:	A-8
City	:	MURRIETA
State	:	CA
Zip	:	92562-5871
Country	:	US
Telephone Number	:	951-698-4034
Fax Number	:	951-698-5076

Provider Business Practice Location Address
First Line	:	39872 LOS ALAMOS RD
Second Line	:	A-8
City	:	MURRIETA
State	:	CA
Zip	:	92562-5871
Country	:	US
Telephone Number	:	951-698-4034
Fax Number	:	951-698-5076

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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