Provider Demographics
NPI:1154860815
Name:INFINITY CHIROPRACTIC AND NUTRITION LLC
Entity Type:Organization
Organization Name:INFINITY CHIROPRACTIC AND NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ZOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-974-0050
Mailing Address - Street 1:99 EDGEBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-1036
Mailing Address - Country:US
Mailing Address - Phone:937-748-0050
Mailing Address - Fax:937-748-0030
Practice Address - Street 1:99 EDGEBROOKE DR
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066
Practice Address - Country:US
Practice Address - Phone:937-748-0050
Practice Address - Fax:937-748-0030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty