Provider Demographics
NPI:1205048527
Name:KOSTZER, DIEGO HERNAN (DC)
Entity type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:HERNAN
Last Name:KOSTZER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9469 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-8561
Mailing Address - Country:US
Mailing Address - Phone:954-432-5775
Mailing Address - Fax:954-432-2525
Practice Address - Street 1:9469 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-8561
Practice Address - Country:US
Practice Address - Phone:954-432-5775
Practice Address - Fax:954-432-2525
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 8420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor