Provider Demographics
NPI:1548379282
Name:ZENNER, SCOTT A (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:ZENNER
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 1:1100 HIGHWAY 25 N
Mailing Address - Street 2:SUITE #4
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-2023
Mailing Address - Country:US
Mailing Address - Phone:763-682-9979
Mailing Address - Fax:
Practice Address - Street 1:1100 HIGHWAY 25 N
Practice Address - Street 2:SUITE #4
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2023
Practice Address - Country:US
Practice Address - Phone:763-682-9979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2694111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN273028600Medicaid
MN359000248Medicare UPIN