Provider Demographics
NPI:1336134659
Name:ZOLLMAN, SCOTT A
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:ZOLLMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 5TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-3116
Mailing Address - Country:US
Mailing Address - Phone:712-546-8151
Mailing Address - Fax:
Practice Address - Street 1:200 5TH AVE NW
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-3116
Practice Address - Country:US
Practice Address - Phone:712-546-8151
Practice Address - Fax:712-546-7653
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA07411OtherWELLMARK BCBS
IA1437370350OtherNPI FOR CLINIC
IA16D0929683OtherCLIA CERTIFICATE NUMBER
IA0159376Medicaid
IA0159376Medicaid
IA07411Medicare PIN