Provider Demographics
NPI:1578722500
Name:ZAHN CHIROPRACTIC CLINIC ( A PROFESSIONAL CORPORATION)
Entity Type:Organization
Organization Name:ZAHN CHIROPRACTIC CLINIC ( A PROFESSIONAL CORPORATION)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:ZAHN
Authorized Official - Suffix:
Authorized Official - Credentials:DE C
Authorized Official - Phone:318-688-1221
Mailing Address - Street 1:1005 SOUTHLAND PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118
Mailing Address - Country:US
Mailing Address - Phone:318-688-1221
Mailing Address - Fax:318-686-4714
Practice Address - Street 1:1005 SOUTHLAND PARK DRIVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118
Practice Address - Country:US
Practice Address - Phone:318-688-1221
Practice Address - Fax:318-686-4714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA374261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAT69649Medicare UPIN
LA59360Medicare PIN