Provider Demographics
NPI:1518331826
Name:SMITH, ZACHARY JOHN (DC)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:JOHN
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 PENNSYLVANIA AVE. W.
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2427
Mailing Address - Country:US
Mailing Address - Phone:814-230-9402
Mailing Address - Fax:
Practice Address - Street 1:327 PENNSYLVANIA AVE W
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2427
Practice Address - Country:US
Practice Address - Phone:814-671-1461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor