Provider Demographics
NPI:1265733604
Name:KOZAK, BETH JOY (DC)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:JOY
Last Name:KOZAK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4043 HOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2171
Mailing Address - Country:US
Mailing Address - Phone:561-622-2466
Mailing Address - Fax:561-622-2606
Practice Address - Street 1:4043 HOOD ROAD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2171
Practice Address - Country:US
Practice Address - Phone:561-622-2466
Practice Address - Fax:561-622-2606
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7712111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition