Provider Demographics
NPI:1083831978
Name:ZOUZAL, WINSEN C (DC)
Entity Type:Individual
Prefix:
First Name:WINSEN
Middle Name:C
Last Name:ZOUZAL
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 1:15761 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-3479
Mailing Address - Country:US
Mailing Address - Phone:313-885-3500
Mailing Address - Fax:313-885-3743
Practice Address - Street 1:15761 MACK AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-3479
Practice Address - Country:US
Practice Address - Phone:313-885-3500
Practice Address - Fax:313-885-3743
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004344111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Q250951Medicare ID - Type Unspecified