Provider Demographics
NPI:1013964402
Name:WEISBROD, ZACH W (DC)
Entity type:Individual
Prefix:DR
First Name:ZACH
Middle Name:W
Last Name:WEISBROD
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 1:1320 S MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-5307
Mailing Address - Country:US
Mailing Address - Phone:515-432-9525
Mailing Address - Fax:
Practice Address - Street 1:1320 S MARSHALL ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-5307
Practice Address - Country:US
Practice Address - Phone:515-432-9525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI17612Medicare PIN
IAU83902Medicare UPIN