Provider Demographics
NPI:1447235544
Name:ZID, DEREK (DC, CNIM)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:ZID
Suffix:
Gender:M
Credentials:DC, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 W NORTH AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1422
Mailing Address - Country:US
Mailing Address - Phone:708-345-1299
Mailing Address - Fax:
Practice Address - Street 1:1440 W NORTH AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1422
Practice Address - Country:US
Practice Address - Phone:708-345-1299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-12
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008863111N00000X
246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU93643Medicare UPIN