Provider Demographics
NPI:1568623114
Name:ZOZZARO GROUP LLC
Entity Type:Organization
Organization Name:ZOZZARO GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOZZARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-862-2225
Mailing Address - Street 1:1713 FORT JESSE ROAD STE D
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761
Mailing Address - Country:US
Mailing Address - Phone:309-862-2225
Mailing Address - Fax:
Practice Address - Street 1:1713 FORT JESSE RD STE D
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-6235
Practice Address - Country:US
Practice Address - Phone:309-862-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008222111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1275581993OtherTYPE 1 NPI