Provider Demographics
NPI:1760936249
Name:ZDRADA, MAXIMILLAN (DC)
Entity Type:Individual
Prefix:DR
First Name:MAXIMILLAN
Middle Name:
Last Name:ZDRADA
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 1:136 N ORCHARD ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-9534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:136 N ORCHARD ST
Practice Address - Street 2:SUITE 3
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-9534
Practice Address - Country:US
Practice Address - Phone:386-310-8096
Practice Address - Fax:386-066-0292
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11916111NI0013X, 111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor