Provider Demographics
NPI:1134282882
Name:ZEGA, MARY H (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:H
Last Name:ZEGA
Suffix:
Gender:F
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:PO BOX 1157
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-0074
Mailing Address - Country:US
Mailing Address - Phone:541-386-5925
Mailing Address - Fax:
Practice Address - Street 1:818 W 6TH ST STE 2
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-1147
Practice Address - Country:US
Practice Address - Phone:541-298-1404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2608111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU-44021OtherPACC
OR54573OtherWA ST DEPT OF LABOR & IND
OR93-1022799OtherTAX IDENTIFICATION NUMBER
OR084004000OtherBLUE CROSS
OR084004000OtherBLUE CROSS
OR93-1022799OtherTAX IDENTIFICATION NUMBER