Provider Demographics
NPI:1538463708
Name:ZOLLNER PRECISION CHIROPRACTIC AND WELLNESS INC.
Entity Type:Organization
Organization Name:ZOLLNER PRECISION CHIROPRACTIC AND WELLNESS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOLLNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:415-499-8469
Mailing Address - Street 1:4380 REDWOOD HWY
Mailing Address - Street 2:SUITE B6
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2120
Mailing Address - Country:US
Mailing Address - Phone:415-499-8469
Mailing Address - Fax:415-499-8645
Practice Address - Street 1:4380 REDWOOD HWY
Practice Address - Street 2:SUITE B6
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2120
Practice Address - Country:US
Practice Address - Phone:415-499-8469
Practice Address - Fax:415-499-8645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0253980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0253980OtherMEDICARE PTAN