Provider Demographics
NPI:1891158945
Name:ZIRKELBACH, JOHN (ATC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ZIRKELBACH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 NAISMITH DR
Mailing Address - Street 2:PAC 1340D
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66045-4069
Mailing Address - Country:US
Mailing Address - Phone:785-331-6272
Mailing Address - Fax:
Practice Address - Street 1:1651 NAISMITH DR
Practice Address - Street 2:PAC 1340D
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66045-4069
Practice Address - Country:US
Practice Address - Phone:785-331-6272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-003782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSPROVIDER CODE 22OtherRESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS