Provider Demographics
NPI:1720003650
Name:ZASTROW CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:ZASTROW CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JED
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ZASTROW
Authorized Official - Suffix:
Authorized Official - Credentials:DC BS
Authorized Official - Phone:623-975-0888
Mailing Address - Street 1:18775 N REEMS RD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-8647
Mailing Address - Country:US
Mailing Address - Phone:623-975-0888
Mailing Address - Fax:623-975-0843
Practice Address - Street 1:18775 N REEMS RD
Practice Address - Street 2:SUITE 360
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8647
Practice Address - Country:US
Practice Address - Phone:623-975-0888
Practice Address - Fax:623-975-0843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7545111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5617285OtherFIRST HEALTH
AZAZ0944850OtherBCBS OF AZ
AZ920000Medicaid
AZ102638Medicare ID - Type Unspecified
AZ920000Medicaid