Provider Demographics
NPI:1750476602
Name:ZDRAZIL, GENE A (DC)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:A
Last Name:ZDRAZIL
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 1:6090 RIVER JUNCTION RD SE
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:IA
Mailing Address - Zip Code:52755-9314
Mailing Address - Country:US
Mailing Address - Phone:319-629-5324
Mailing Address - Fax:
Practice Address - Street 1:6090 RIVER JUNCTION RD SE
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:IA
Practice Address - Zip Code:52755-9314
Practice Address - Country:US
Practice Address - Phone:319-629-5324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4757111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1174706Medicaid
IA1174706Medicaid
IAT01012Medicare UPIN