Provider Demographics
NPI:1831117936
Name:ZOOK CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:ZOOK CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZOOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:850-678-4155
Mailing Address - Street 1:1148 E. JOHN SIMS PKWY
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578
Mailing Address - Country:US
Mailing Address - Phone:850-678-4155
Mailing Address - Fax:850-678-1855
Practice Address - Street 1:1148 JOHN SIMS PKWY E
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2204
Practice Address - Country:US
Practice Address - Phone:850-678-4155
Practice Address - Fax:850-678-1855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID