Provider Demographics
NPI:1922663095
Name:NOWICKI, ZACHARY ALEXANDER (DC)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:ALEXANDER
Last Name:NOWICKI
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 1:34 SEAMAN AVE
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-2016
Mailing Address - Country:US
Mailing Address - Phone:631-418-6378
Mailing Address - Fax:
Practice Address - Street 1:680 ROUTE 112
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1344
Practice Address - Country:US
Practice Address - Phone:631-289-3939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-04
Last Update Date:2019-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013155111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor