MEDICARE: DR. GARY L KOLOSIK 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	4878	IA

General Provider Information

NPI Number	:	1689667412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY L KOLOSIK D.C.

Provider Business Mailing Address
First Line	:	213 S MAIN ST
Second Line	:	PO BOX 268
City	:	NORTH ENGLISH
State	:	IA
Zip	:	52316-9518
Country	:	US
Telephone Number	:	319-664-3145
Fax Number	:

Provider Business Practice Location Address
First Line	:	213 S MAIN ST
Second Line	:
City	:	NORTH ENGLISH
State	:	IA
Zip	:	52316-0268
Country	:	US
Telephone Number	:	319-664-3145
Fax Number	:

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	11/01/2007

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