Provider Demographics
NPI:1689727778
Name:ZVONAR, CARROLLE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:CARROLLE
Middle Name:ANN
Last Name:ZVONAR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31864 QUINLAN AVE
Mailing Address - Street 2:
Mailing Address - City:CENTER CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55012-7636
Mailing Address - Country:US
Mailing Address - Phone:651-307-7524
Mailing Address - Fax:
Practice Address - Street 1:11494 BRINK AVE
Practice Address - Street 2:
Practice Address - City:CHISAGO CITY
Practice Address - State:MN
Practice Address - Zip Code:55013-9411
Practice Address - Country:US
Practice Address - Phone:651-257-3914
Practice Address - Fax:651-257-3915
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN002174111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN52P45ZVOtherBCBS PROVIDER NUMBER
MN668226000Medicaid