MEDICARE: KOSAK CHIROPRACTIC P.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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC7658	OTHER	NE	RAILROAD MEDICARE GROUP #

General Provider Information

NPI Number	:	1558416230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOSAK CHIROPRACTIC P.C.

Provider Business Mailing Address
First Line	:	14450 EAGLE RUN DR
Second Line	:	STE. 150
City	:	OMAHA
State	:	NE
Zip	:	68116-1493
Country	:	US
Telephone Number	:	402-964-0300
Fax Number	:	402-964-0058

Provider Business Practice Location Address
First Line	:	14450 EAGLE RUN DR
Second Line	:	STE. 150
City	:	OMAHA
State	:	NE
Zip	:	68116-1493
Country	:	US
Telephone Number	:	402-964-0300
Fax Number	:	402-964-0058

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HEIDI LYN KOSAK
Credential	:	D.C.
Telephone Number	:	402-964-0300

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/15/2008

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Directions to “KOSAK CHIROPRACTIC P.C. ” Practice Location

Language	Start Address	Practice Location

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