Provider Demographics
NPI:1962454678
Name:ZANNETTI, MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:ZANNETTI
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 1:5584 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2928
Mailing Address - Country:US
Mailing Address - Phone:440-442-6969
Mailing Address - Fax:440-442-8312
Practice Address - Street 1:5584 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2928
Practice Address - Country:US
Practice Address - Phone:440-442-6969
Practice Address - Fax:440-442-8312
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1073111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH23009OtherQUALCHOICE INS.
OH341292394OtherWORKERS' COMPENSATION
OHU74493Medicare UPIN
OH341292394OtherWORKERS' COMPENSATION
OH23009OtherQUALCHOICE INS.