MEDICARE: GEORGE K KOSMIDES DC INC PROFESSION OF CHIROPRACTIC

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

General Provider Information

NPI Number	:	1598951147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE K KOSMIDES DC INC PROFESSION OF CHIROPRACTIC

Provider Business Mailing Address
First Line	:	4849 VAN NUYS BLVD
Second Line	:	SUITE 206
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-2110
Country	:	US
Telephone Number	:	818-788-4325
Fax Number	:	818-206-8623

Provider Business Practice Location Address
First Line	:	4849 VAN NUYS BLVD
Second Line	:	SUITE 206
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-2110
Country	:	US
Telephone Number	:	818-788-4325
Fax Number	:	818-206-8623

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GEORGE K KOSMIDES
Credential	:	D.C.
Telephone Number	:	808-960-8283

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	06/30/2009

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