Provider Demographics
NPI:1124031679
Name:ZOLLNER, CHARLES (DC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:ZOLLNER
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 1:4380 REDWOOD HWY STE B6
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2110
Mailing Address - Country:US
Mailing Address - Phone:415-747-8980
Mailing Address - Fax:415-499-8645
Practice Address - Street 1:4380 REDWOOD HWY STE B6
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2110
Practice Address - Country:US
Practice Address - Phone:415-747-8980
Practice Address - Fax:415-499-8645
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25398111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0253980Medicare ID - Type Unspecified
U71683Medicare UPIN