Provider Demographics
NPI:1790735660
Name:ZEGA, BRUCE E (DC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:E
Last Name:ZEGA
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 1:208 SECOND ST
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031
Mailing Address - Country:US
Mailing Address - Phone:541-386-2151
Mailing Address - Fax:541-386-2995
Practice Address - Street 1:208 SECOND ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031
Practice Address - Country:US
Practice Address - Phone:541-386-2151
Practice Address - Fax:541-386-2995
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR59617OtherDEPT OF LABOR AND IND
OR08354500OtherBC BS OF OR
OR59617OtherDEPT OF LABOR AND IND
OR000QGFKWMedicare ID - Type Unspecified