Provider Demographics
NPI:1508879735
Name:ZAJAC, KARA LEE (DC)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:LEE
Last Name:ZAJAC
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6564 HIGHWAY 53 E
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-6806
Mailing Address - Country:US
Mailing Address - Phone:706-265-7339
Mailing Address - Fax:706-216-1209
Practice Address - Street 1:6564 HIGHWAY 53 E
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6806
Practice Address - Country:US
Practice Address - Phone:706-265-7339
Practice Address - Fax:706-216-1209
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA6581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4556Medicare ID - Type Unspecified