Provider Demographics
NPI:1275755647
Name:ZDILLA FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:ZDILLA FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ZDILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-929-6777
Mailing Address - Street 1:1179 ROSTRAVER RD
Mailing Address - Street 2:
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-4504
Mailing Address - Country:US
Mailing Address - Phone:724-929-6777
Mailing Address - Fax:888-221-7407
Practice Address - Street 1:1179 ROSTRAVER RD
Practice Address - Street 2:
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012-4504
Practice Address - Country:US
Practice Address - Phone:724-929-6777
Practice Address - Fax:888-221-7407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1593143OtherHIGHMARK GROUP NUMBER