MEDICARE: DR. THEODORE M KOZIOL 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	38MC00329800	NJ

General Provider Information

NPI Number	:	1578684155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THEODORE M KOZIOL DC

Provider Business Mailing Address
First Line	:	387 BRICK BLVD
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08723-6010
Country	:	US
Telephone Number	:	732-477-6767
Fax Number	:	732-477-9333

Provider Business Practice Location Address
First Line	:	387 BRICK BLVD
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08723-6010
Country	:	US
Telephone Number	:	732-477-6767
Fax Number	:	732-477-9333

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	09/16/2013

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