Provider Demographics
NPI:1508541954
Name:MEADOWS, ZACHARY (LAC)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:MEADOWS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5713 N PERSHING AVE STE A2
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-4946
Mailing Address - Country:US
Mailing Address - Phone:209-373-9009
Mailing Address - Fax:
Practice Address - Street 1:5713 N PERSHING AVE STE A2
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-4946
Practice Address - Country:US
Practice Address - Phone:209-373-9009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19347171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist