Provider Demographics
NPI:1699965343
Name:KOZIEJ, GERALD BERNARD (DC)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:BERNARD
Last Name:KOZIEJ
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 1:211 IOLA RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2915
Mailing Address - Country:US
Mailing Address - Phone:502-721-0265
Mailing Address - Fax:
Practice Address - Street 1:3225 BRECKENRIDGE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-3211
Practice Address - Country:US
Practice Address - Phone:502-491-0345
Practice Address - Fax:502-491-0347
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor