Provider Demographics
NPI:1679210017
Name:ZEN SPINE & SPORT
Entity Type:Organization
Organization Name:ZEN SPINE & SPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:VAN VELDHUIZEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-610-2539
Mailing Address - Street 1:5705 NW 100TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-1858
Mailing Address - Country:US
Mailing Address - Phone:515-776-8687
Mailing Address - Fax:
Practice Address - Street 1:5705 NW 100TH ST STE 200
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1858
Practice Address - Country:US
Practice Address - Phone:515-776-8687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-17
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty