Provider Demographics
NPI:1326055443
Name:ZARBUCK, GWAIN R II (DC)
Entity Type:Individual
Prefix:DR
First Name:GWAIN
Middle Name:R
Last Name:ZARBUCK
Suffix:II
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 1:711 W SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-3110
Mailing Address - Country:US
Mailing Address - Phone:217-328-3348
Mailing Address - Fax:217-383-1003
Practice Address - Street 1:711 W SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-3110
Practice Address - Country:US
Practice Address - Phone:217-328-3348
Practice Address - Fax:217-383-1003
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP15639Medicare ID - Type Unspecified