Provider Demographics
NPI:1467533497
Name:ZEN PHYSICAL MEDICINE LTD
Entity Type:Organization
Organization Name:ZEN PHYSICAL MEDICINE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-395-8676
Mailing Address - Street 1:5301 E STATE ST
Mailing Address - Street 2:SUITE112
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2901
Mailing Address - Country:US
Mailing Address - Phone:815-395-8676
Mailing Address - Fax:815-395-1751
Practice Address - Street 1:5301 E STATE ST
Practice Address - Street 2:SUITE112
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2388
Practice Address - Country:US
Practice Address - Phone:815-395-8676
Practice Address - Fax:815-395-1751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1023095155OtherINDIVIDUAL NPI #
IL038-009452OtherCHIROPRACTIC LICENSE #
IL1023095155OtherINDIVIDUAL NPI #
IL938100Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #