Provider Demographics
NPI:1639218076
Name:VUKOVIC, ZVONKO IVAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ZVONKO
Middle Name:IVAN
Last Name:VUKOVIC
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 1:4365 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-2133
Mailing Address - Country:US
Mailing Address - Phone:440-967-4226
Mailing Address - Fax:440-967-0296
Practice Address - Street 1:4365 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-2133
Practice Address - Country:US
Practice Address - Phone:440-967-4226
Practice Address - Fax:440-967-0296
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11361263OtherCAQH
OH46-0520580OtherTAX ID
OH000000513505OtherANTHEM
OH4148721Medicare ID - Type UnspecifiedMEDICARE
OH11361263OtherCAQH