Provider Demographics
NPI:1316028137
Name:ZYLKER, KENNETH J (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:ZYLKER
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 1:15520 ROCKFIELD BLVD A200
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-6705
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:2255 MORELLO AVE
Practice Address - Street 2:107
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1824
Practice Address - Country:US
Practice Address - Phone:925-825-5420
Practice Address - Fax:925-825-8706
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19014111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0190140OtherBLUE SHIELD
CAT06754Medicare UPIN
CADC0190140Medicare ID - Type Unspecified