Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH 11353 | FL |
NPI | 1003214917 |
---|---|
Provider Name | Dr. Trent Gregory Kozman |
First Address | Port Orange, FL 32129-6058 |
Second Address | South Daytona, FL 32119-3539 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2014 |
Last Update Date | 09/12/2014 |