Provider Demographics
NPI:1013448356
Name:GLEN ZIELINSKI DC PC
Entity Type:Organization
Organization Name:GLEN ZIELINSKI DC PC
Other - Org Name:NORTHWEST FUNCTIONAL NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIELINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-850-4526
Mailing Address - Street 1:4035 MERCANTILE DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-2546
Mailing Address - Country:US
Mailing Address - Phone:503-850-4526
Mailing Address - Fax:503-908-1555
Practice Address - Street 1:17449 LOWER BOONES FERRY
Practice Address - Street 2:SUITE 300
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-2546
Practice Address - Country:US
Practice Address - Phone:503-850-4526
Practice Address - Fax:503-908-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3228111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty