Provider Demographics
NPI:1619027026
Name:ZELLWEGER FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:ZELLWEGER FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:ZELLWEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:603-899-5153
Mailing Address - Street 1:1102 NH ROUTE119
Mailing Address - Street 2:
Mailing Address - City:RINDGE
Mailing Address - State:NH
Mailing Address - Zip Code:03461
Mailing Address - Country:US
Mailing Address - Phone:603-899-5153
Mailing Address - Fax:
Practice Address - Street 1:1102 NH ROUTE 119
Practice Address - Street 2:
Practice Address - City:RINDGE
Practice Address - State:NH
Practice Address - Zip Code:03461
Practice Address - Country:US
Practice Address - Phone:603-899-5153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH778-1206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RE8998Medicare PIN