Provider Demographics
NPI:1629536057
Name:ZELLWEGER FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:ZELLWEGER FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:ZELLWEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-706-2378
Mailing Address - Street 1:1 MALLETT WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6066
Mailing Address - Country:US
Mailing Address - Phone:843-706-2378
Mailing Address - Fax:
Practice Address - Street 1:10747 FORD AVE STE 5
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-9027
Practice Address - Country:US
Practice Address - Phone:912-756-3004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ZELLWEGER FAMILY CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty