Provider Demographics
NPI:1891212759
Name:ZELLWEGER FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:ZELLWEGER FAMILY CHIROPRACTIC
Other - Org Name:ISLANDS CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZELLWEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-706-2378
Mailing Address - Street 1:1 MALLETT WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6066
Mailing Address - Country:US
Mailing Address - Phone:843-706-2378
Mailing Address - Fax:
Practice Address - Street 1:461 JOHNNY MERCER BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-2218
Practice Address - Country:US
Practice Address - Phone:843-707-2826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty