Provider Demographics
NPI:1164548160
Name:ZIC, PAUL EDWARD (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:EDWARD
Last Name:ZIC
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 1:18784 COX AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-4109
Mailing Address - Country:US
Mailing Address - Phone:408-374-9033
Mailing Address - Fax:408-374-9361
Practice Address - Street 1:18784 COX AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-4109
Practice Address - Country:US
Practice Address - Phone:408-374-9033
Practice Address - Fax:408-374-9361
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor