Provider Demographics
NPI:1043321854
Name:ZUCKERMAN, ROBERT MARK (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARK
Last Name:ZUCKERMAN
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 1:3180 WILLOW LN 112
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4983
Mailing Address - Country:US
Mailing Address - Phone:805-494-0550
Mailing Address - Fax:805-494-9751
Practice Address - Street 1:3180 WILLOW LN 112
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-4983
Practice Address - Country:US
Practice Address - Phone:805-494-0550
Practice Address - Fax:805-494-9751
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19341111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770230670OtherTAX ID #
CA770230670OtherTAX ID #
CAT82731Medicare UPIN